2. Intermittent Sources of Stress* For each of the events that occurred during the past 12 months or so, indicate your emotional impact score (j.e., write in a number from “1? low impact, to “10," major impact). Impact may be positive or negative; scoring only reflects magnitude. “Emotional Impact” is the force that tends to disturb your emotional balance or equilibrium, or the energy you require to get back to “feeling normal.’ Only score events that occurred—skip items that did not occur during the past 12 months, or that don’t apply. Emotional Impact Score ost my job, retired, or expect to lose my job, or | failed a class. b | was criticized by my boss or passed over for a promotion I changed my place of residence. 4 A person close to me ended or changed the nature of our relationship. e | got married, reconciled, separated, or divorced. 1 | received evaluations at work or school that were unexpected. 9 I wasn't adequately prepared for a deadline or assignment. h | received some special recognition or scholastic honor i Iwas reprimanded or put on probation. j, _______ I dropped a course atter investing time to master it k. | changed smoking, drinking, or eating habits. L ___ Acclose friend was transferred or graduated and lett. m, ‘An important source of income was interrupted, reduced, or ended A Iwas assigned a new boss. °. Anew family member was added (birth, adoption, moving in) Pp. Work or school assignments interfered with my personal lite q. —_____ I terminated a subordinate. r Major policy or procedural changes at work or school suddenly occurred.s. | had trouble with co-workers or group members. t. _____ I was criticized by my boss, or | was the one criticizing others openly. If not covered above, add two emotionally unsettling events or experiences that occurred during the past year or so, and were intermittent in nature. These may be positive or negative such as: a Blind date, visit from your parents, seeing someone cheat on an exam, pregnancy, litigation, car breaking down, etc. Emotional impact Score uw v Total for emotional impact score (a-).3. Ongoing Sources of Stress For each of the events that occurred during the past month or so, indicate your emotional impact score ("1," low impact, to “10,” maj example, assume you judged a “6” impact), then place the 6 in impact). After you have assessed the emotional impact (for ther column A or B, whichever is applicable. Alternatively, you may divide your score between Columns A and B (for example, scoring “4° in Column A, and "2" in Column B). Only score events that occurred—skip items that didn’t occur or aren't applicable. Emotional Impact Score Events Beyond My Power to Change Column A. Events Within My Power to Change Column 8 | have continuing problems or lack of closeness with my parents or relatives, I don't fee! as healthy as I'd like. Job security is a problem. | am not satisfied with my career or school progression. | must attend meetings that waste time. ‘The activities or work schedule of my spouse or close friends create continuing problems. | fee! under-appreciated at home or in my personal life Family members have chronic or addictive problems. My lifestyle lacks adventure or doesn't serve my deepest needs. Heel my performance is not evaluated appropriately. 1 am involved with too much, or not enough, travel. ‘My subordinates (or group members) are not as motivated as | would like them to be. | am not satisfied with my compensation or benefits or grades. \ don't have enough intimacy or satisfaction in my primary telationship—or | want one and don’t have it. Traffic congestion, commuting, or related problems are excessive. Expressing my feelings is a problem for me.| | experience continuing relationship conflicts ————. |. Work or school situations create personal or ethical concerns. 8. | have inadequate social interactions or friendships at work or school, If not covered above, add on two emotional events that occurred during the past month or so (positive or negative). Total for Emotional Impact Score: Column A Column B