“Normally we do not so much look at things as overlook them.” - Alan Watts
Real People, Real Stories
The Stress Management 101 class was about to begin. Today's topic was Assessing Your Stress. Angie sat quietly in the back of the classroom. “Ok class, let's start by checking our resting heart rate”, the teacher announced. Angie's pulse was 105 beats per minute. “Next, check the number of breaths you take per minute.” Angie counted 30 breaths. “How long does it usually take you to fall asleep once you lie down at night?” Angie said it usually takes about two hours. “How much of the time do you feel high levels of stress?” Angie said she feels that way almost all the time. “Doesn't that feel unpleasant to always feel so stressed?” the teacher questioned. Angie's reply was both sad and common among college students, “I didn't know there was another way to feel. I assumed this was the way college life was supposed to be, and that everyone feels this way.”
Several years ago author Richard Carlson created a very catchy title for his best-selling book, Don't Sweat the Small Stuff…It Is All Small Stuff. He offered some important advice for our over-stressed society. We need to step back and relax. That is great advice. The problem is, not all stuff is small stuff. Some things are worth sweating over. The tricky part is determining what is really important and worthy of your energy and what is the “small stuff” that causes needless worry and decreases the quality of your life.
One of the great challenges for successful stress management is determining what it is that causes you stress. A certain level of stress can energize and motivate you to deal with the important issues in your life. You want to focus your energy on those things in your life that are truly important. How do you determine what factors are causing unnecessary stress? Is my stress level normal? These are important questions we will answer in this chapter.
Where Are You Now?
How do you assess stress? How do you measure stress? In this chapter, you will find a variety of tools to help assess your stress. Some of these tools are simple and fun. Some are more scientific and complex. Each of them has been selected to increase your understanding of stress in your life. Each of these tools will provide information that you can use to develop a stress management program that works for you. The first step in developing a plan is assessment. Assessing where you stand right now is critical to making progress in achieving a balanced life. As Alan Watts stated in our chapter quote, “Normally we do not so much look at things as overlook them.” This quote contains real truth. You may be so busy living your life that you don't take time to stop and assess. You just keep doing what you are doing.
There is not one best tool for assessing stress, in part because reactions to events vary from person to person. What absolutely frazzles one person may excite and positively challenge another. Research supports the idea that it is not the actual stress that matters most, but our ability to control how we perceive and react to the situation that contributed to the stress. External events do not cause stress; how we perceive and cope with them does.
It is important to know that the information you gain from the assessments in this chapter is for you to take and use as it seems relevant to you and your life. These assessments and surveys are not intended to be diagnostic, but only to guide you in understanding yourself better. Taken together you will discover an overall picture of your current stress status. This will help you decide where you want to go and how you can get there.
Begin with a few simple, yet informative, measures of potential stress. Using the Assess Stress Table, fill in your response for each item based on the instructions following the table.
Assess Stress Table
Resting Heart Rate
______ Beats per minute
_______ Abdomen _______Chest _______ Both
______ Breaths per minute
Resting Heart Rate
Check your resting heart rate (pulse) after you have been sitting or relaxing for a period of time. You will need a watch or clock with a second hand (or digital seconds). First, find your pulse. You can find your radial pulse on the thumb side of your wrist or your carotid pulse on your neck just under the jaw. For sixty seconds count the number of beats that you feel. Place this number in the first line of the Assess Stress Table.
Next, find a chair that has a back to it. Sit in the chair so your back is primarily straight up and down against the back of the chair. Place one hand on your abdomen with your palm covering your navel. Place your other hand on the upper part of your chest with the palm of that hand just above the heart. For a minute or two, become very aware of your breathing. While sitting straight up, notice your breath as it goes in and comes back out. Become aware of your hands as you breathe in and out. Which one seems to move more? Is it your abdominal hand or your chest hand? Or do they both move equally?
Try this second technique to see if you get the same results. First, breathe out and empty your lungs. Count to three as you inhale deeply. Now, hold it. Did your shoulders go up? Did you feel like the air filled the upper part of your lungs? If so, you probably lean toward chest breathing. If you are a diaphragmatic breather, you would feel your abdominal area expand, your belt tighten, and fullness in the lower part of your lungs and chest. Record your results on the Assess Your Stress Table.
Now, for about a minute, become aware of your breathing again. This time, just count how many natural, effortless breaths you take in a minute. Be sure to breathe as normally and naturally as possible. Each inhalation and exhalation cycle is considered one breath. The number of breathes in one minute is your respiration rate. Record the number of breaths you take per minute in the Assess Your Stress table.
Another self-assessment is the Stress-o-meter. Think back over the last month of your life. Include all of your waking moments, as you think back. Give yourself a rating according to the following scale. A score of “1” would indicate that you feel your life has been relatively stress-free during that period. You have felt blissful, calm, peaceful and serene at all times. You have been able to adapt and “flow” with situations as they arise. A “10” score would mean that you felt very high anxiety most of the time. You may have had periods bordering on neurosis, suicidal, or very depressed feelings. A score of 10 would mean that this was a month packed with high levels of stress.
Considering the last month as one single period of time, it is most likely that you would rank yourself somewhere between these two extremes. If you were to average the month (we all have highs and lows), what number would you give yourself on this scale from 1 to 10? Make a note of this number on the Assess Your Stress Table. We will refer to this number again later.
Assess Your Stress Results
Many factors are involved in determining a general level of stress. A couple physiological measures that relate to increased stress are increased heart rate and increased respiration rate. While there are many factors that affect these rates, you will learn in chapter three why the stress response can increase your pulse and respiration rates. The average pulse rate for an adult is approximately 70-80 beats per minute. The average respiration rate is around 12-16 breaths per minute. A faster heart beat or breathing rate might be an indicator of higher than desired stress levels.
Were you primarily a chest breather or an abdominal breather? Many of us are primarily chest, or thoracic, breathers. Chest breathers tend to take shallower breathes. Diaphragmatic, or abdominal, breathing involves the abdominal muscles to facilitate deeper breathing. This allows you to take in more oxygen with each breath. Later you will learn more about why deep breathing is effective as an important relaxation technique.
Your perception of stress primarily determines how your body responds. The Stress-o-meter increases your awareness of the level of stress you perceive in your life. When we exercise we can follow a perceived exertion scale that will give us some idea of how hard we are exercising. We can determine our intensity level. Similarly, we can use the Stress-o-meter to assess our general levels of perceived stress over the past month. You will learn later in the book how your perception of stress relates to your health and your physiological responses. Your body responds the same, whether the stress is real or imagined, so your perception becomes your reality.
Now, look back over your results recorded in the Assess Your Stress Table. What does this information tell you about your stress level?
Research Highlight - Stress Seems to Block Deep Sleep
Stress may disrupt the natural rhythms of the body's nervous system during various stages of sleep, according to a study in the journal Psychosomatic Medicine. This study found stressed sleepers wake up more often while they are sleeping and have fewer episodes of deep sleep. The link between daytime stress and restless sleep is well established, but scientists are still investigating the exact ways that stress affects sleep.
Researchers monitored the heart rates of 59 healthy undergraduate students while they slept. Heart rate variations can provide clues about the activity of the autonomic nervous system, which controls the function of organs such as the heart and lungs. To trigger stress during sleep, the researchers told half of the students they would have to deliver a 15-minute speech when they woke up. The topics would be chosen for them upon awakening, the students were told.
The researchers detected significant heart rate variations between the stressed and non-stressed students as they slept. The stressed group had changes in heart rate patterns during REM, or rapid-eye-movement, sleep - the sleep phase when dreaming occurs - and non-REM sleep. The heart rate variability patterns detected in the stressed students were similar to those seen in people with insomnia, the study revealed, suggesting similar pathways of nervous system disruption. (, news release, )
Symptoms of Stress
How frequently do you find yourself experiencing such problems as headaches, problems going to sleep or staying asleep, unexplained muscle pain, jaw pain, uncontrolled anger, and frustration? Using the table below, assess the frequency that you experience these common symptoms of stress.
Frequency of symptoms
Almost all day, every day
Once or twice daily
Every night or day
2-3 times per week
Once a week
Once a month
Tense muscles, sore neck and back
Anxiety, worry, phobias
Difficulty falling asleep
Bouts of anger/hostility
Eating too much or too little
Diarrhea, cramps, gas, constipation
Restlessness, itching, tics
The more often you experience these symptoms of stress, the more likely stress is having a negative impact on your life. Like Angie in our opening vignette, you may be so used to feeling a certain way that you assume this is normal. Look back over the Symptoms of Stress Table. Are there symptoms of stress that you would like to eliminate or change? In later chapters you will learn proven strategies to help eliminate the negative symptoms of stress.
FYI - Lesson From the Titanic
The blockbuster movie Titanic has a health lesson for us all. The captain of that mighty ship was warned six separate times to slow down, change course and take the southern route because icebergs had been sighted. But, he ignored all six specific warnings, lulled into complacency of believing that the ship was unsinkable. The lesson is listen to your body when it sends you signals. Symptoms and changes are warnings that you should slow down, change course, or take another route.
Perceived Stress Scale
A more precise measure of personal stress can be determined by using a variety of instruments that have been designed to help measure individual stress levels. The first of these is called the Perceived Stress Scale
The Perceived Stress Scale (PSS) is a classic stress assessment instrument. This tool, while originally developed in 1983, remains a popular choice for helping us understand how different situations affect our feelings and our perceived stress. The questions in this scale ask about your feelings and thoughts during the last month. In each case, you will be asked to indicate how often you felt or thought a certain way. Although some of the questions are similar, there are differences between them and you should treat each one as a separate question. The best approach is to answer fairly quickly. That is, don't try to count up the number of times you felt a particular way; rather indicate the alternative that seems like a reasonable estimate.
For each question choose from the following alternatives:
0 - never
1 - almost never
2 - sometimes
3 - fairly often
4 - very often
____ 1. In the last month, how often have you been upset because of something that happened unexpectedly?
_____ 2. In the last month, how often have you felt that you were unable to control the important things in your life?
_____ 3. In the last month, how often have you felt nervous and stressed?
_____ 4. In the last month, how often have you felt confident about your ability to handle your personal problems?
_____ 5. In the last month, how often have you felt that things were going your way?
_____ 6. In the last month, how often have you found that you could not cope with all the things that you had to do?
_____ 7. In the last month, how often have you been able to control irritations in your life?
_____ 8. In the last month, how often have you felt that you were on top of things?
_____ 9. In the last month, how often have you been angered because of things that happened that were outside of your control?
_____ 10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?
Figuring your PSS score:
You can determine your PSS score by following these directions:
First, reverse your scores for questions 4, 5, 7, & 8. On these 4 questions, change the scores like this: 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0.
Now add up your scores for each item to get a total. My total score is ______.
Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress.
Scores ranging from 0-13 would be considered low stress.
Scores ranging from 14-26 would be considered moderate stress.
Scores ranging from 27-40 would be considered high perceived stress.
The Perceived Stress Scale is interesting and important because your perception of what is happening in your life is most important. Consider the idea that two students, John and Dan, could have the exact same events and experiences in their lives for the past month. Depending on their perception, John's total score could put him in the low stress category and Dan's total score could put him in the high stress category. Consider the words of Ralph Waldo Emerson, “Nothing can bring you peace but yourself.”
The Inventory of College Students' Recent Life Experiences
Another useful scale used to measure stress levels in a different way is called The Inventory of College Students' Recent Life Experiences (ICSRLE). The ICSRLE was designed to identify individual exposure to sources of stress or hassles and allow for an identification of the extent to which those stressors are experienced over the past month. The ICSRLE was developed uniquely for college students. As you know, the sources of stress in a university environment can be unique and different from other settings.
What do college students typically perceive to be the major sources of stress? The ICSRLE is helpful in assessing the major sources of stress and in identifying individual exposure to sources of stress or hassles. This inventory also allows for an identification of the extent to which those stressors are experienced over the past month.
The following is a list of experiences which many students have some time or other. Please indicate for each experience how much it has been a part of your life over the past month. Mark your answers according to the following guide:
Intensity of Experience over the Past Month
0 = not at all part of my life
1 = only slightly part of my life
2 = distinctly part of my life
3 = very much part of my life
____1. Conflicts with boyfriend's/girlfriend's/spouse's family
____2. Being let down or disappointed by friends
____3. Conflict with professor(s)
____4. Social rejection
____5. Too many things to do at once
____6. Being taken for granted
____7. Financial conflicts with family members
____8. Having your trust betrayed by a friend
____9. Separation from people you care about
____10. Having your contributions overlooked
____11. Struggling to meet your own academic standards
____12. Being taken advantage of
____13. Not enough leisure time
____14. Struggling to meet the academic standards of others
____15. A lot of responsibilities
____16. Dissatisfaction with school
____17. Decisions about intimate relationship(s)
____18. Not enough time to meet your obligations
____19. Dissatisfaction with your mathematical ability
____20. Important decisions about your future career
____21. Financial burdens
____22. Dissatisfaction with your reading ability
____23. Important decisions about your education
____25. Lower grades than you hoped for
____26. Conflict with teaching assistant(s)
____27. Not enough time for sleep
____28. Conflicts with your family
____29. Heavy demands from extracurricular activities
____30. Finding courses too demanding
____31. Conflicts with friends
____32. Hard effort to get ahead
____33. Poor health of a friend
____34. Disliking your studies
____35. Getting “ripped off” or cheated in the purchase of services
____36. Social conflicts over smoking
____37. Difficulties with transportation
____38. Disliking fellow student(s)
____39. Conflicts with boyfriend/girlfriend/spouse
____40. Dissatisfaction with your ability at written expression
____41. Interruptions of your school work
____42. Social isolation
____43. Long waits to get service (e.g., at banks, stores, etc.)
____44. Being ignored
____45. Dissatisfaction with your physical appearance
____46. Finding course(s) uninteresting
____47. Gossip concerning someone you care about
____48. Failing to get expected job
Stress, Mental Health Functioning, and Stress Management Interventions
Stress is a major component of most people’s lives. The handling of stress is where people are different from each other’s. Different people can handle different stress levels. When stress gets to the point in your life that you are impacted in a negative way, then you need stress management interventions. Interventions can be self-taught, obtained through a professional therapist or counselor, and can be simple tricks used to bring relief.
If stress is an occasional part of your life, you can use self-taught programs or tools to help the minor situations. Soothing music, a mantra, or a quick walk can all bring your down from a stressful situation. There are thousands of books offering tools for immediate distressing. However, if these tools do not work, you may need to turn to a professional to help with your problem.
The last result for stress management intervention would be a prescribed medication to alleviate the problem, so the therapist or counselor will try different techniques before getting to that point. A series of sessions in which the doctor speaks to the client about the stress in his or her life will first take place. As the patient works his or her way through these sessions, devices and tricks will be given for relieving stress. In some extreme cases, a medication will be needed and the counseling appointments may be an on-going tool needed for stress maintenance.
Tricks or clever tools can be used as a stress intervention whether the person is self-taught or using a professional. What works for one person to relieve stress may not necessarily work for another person. There will be a period of trail and error to find what works. It is important to evaluate the situation and determine if you can change it, if it is important to you, and if walking away from it is a possibility. Learning to know what causes stress and why you get stressed is just as important as learning what works to relieve the stress in your life.
If stress is happening too much in your life, you may want to visit a counselor or therapist, explore written materials on the subject, and implement simples tricks to bring your blood pressure down and put a smile on your face. These tools can be just the interventions you need for a stress-free life.