SAFE Stress Questionnaire

To get your SAFE mood score, use the drop down options next to each statement to indicate frequency over the last 14 days.

1. I have felt sad and/or lonely.*
2. I have felt trapped, and/or anxious.*
3. I have felt resentful of others close to me and/or life events.*
4. I have felt bad about myself, and/or a failure, and/or lost my confidence, and/or let people down.*
5. I have felt hopeless, and/or unable to solve my problems.*
6. I have felt isolated and/or abandonned.*
7. I have felt rejected by others close to me.*
8. I have felt betrayed by others close to me.*
9. I have felt worried about my future.*
10. I have felt low and/or depressed.*
11. I have felt uncertainty and/or not knowing about my future.*
12. I have felt unfairness and/or bitterness about my life.*
13. I have felt guilt and/or shame about my behaviour or thoughts.*
14. I have felt controlled by others and/or life events.*
15. I have felt jealous/envious of others.*
16. I have been more intolerant/impatient/irritated by others close to me.*
17. I have suffered with Falling asleep, staying asleep, too much sleep, and/or not getting 7 hours nightly.*
18. I have suffered with irritable bowl and/or acid reflux.*
19. I have suffered with thoughts of ending my life. (Eg: "I don’t want to wake up tomorrow")*
20. I have suffered excessive weight gain or weight loss.*
21. I have suffered stress at work. (Eg Change of role/hours/dispute with manager/colleagues/ bullying.)*
22. I have stopped eating 3 healthy meals per day, and/or enjoying my food, and/or skipped breakfast.*
23. I have stopped doing regular Housework/Gardening/Laundry/Cooking etc. (let things slide)*
24. I have stopped showering or bathing regularly and/or caring about my appearance.*
25. I have stopped talking to my friends and family as often as usual and/or using social media as often.*
26. I have stopped exercising regularly and/or not putting in the same level of effort.*
27. I have stopped doing the things I used to enjoy. EG: Sports/Hobbies/Interests/Creative Arts*
28. I have had no sexual intimacey in my relationship/marriage (may or may not cause conflicts).*
29. I have had no affection in my close loving relationships (Eg: hugs, hisses, cuddles, holding hands etc).*
30. I have had more arguments/conflicts with my partner, children, parents, work colleagues, etc.*
31. I have been overeating food high in fat and sugar EG: crisps, cakes, biscuits, snacks & junk food.*
32. I have experienced negative changes in my life. (EG: Bereavement, Separation, loss of income)*
33. I have taken alcohol with a meal (EG glass of wine, beer or spirits) and/or drinking more than usual.*
34. I have become drunk, out of control, and/or violent, and/or verbally abusive from excess Alcohol.*
35. I have lost pleasure in doing things and/or felt overwhelmed by life events/circumstances.*
36. I have been binge watching TV and/or Netfilx and/or Pornography*
37. I have struggled to leave my home.*
38. I have been excessively tired and lethargic (everything an effort, like "walking in treacle" /sedentary).*
39. I have been smoking Cannabis/Skunk/Weed/Hash*
Questions 40 - 50 require a Yes or No answer.
40. I have been taking GP prescribed medication for any health condition. (Except Vitamin supplements)*
41. I have been caring for a family member/close friend who is dependent/terminal/suffering dementia.*
42. I have been taking GP prescribed mood medications. (EG: Anti-depressants/Anti-anxiety tablets)*
43. I have suffered bereavement of someone and/or a pet close to me.*
44. I have been made redundant/ furloughed/ lost income source.*
45. I have been stressed about financial debt that I cannot pay back.*
46. I have taken recreational drugs (Cocaine, Ecstasy, Heroin, Acid, etc)*
47. I have had a new baby in my household.*
48. I have attempted to commit suicide.*
49. I have been hospitalised and/or diagnosed with a terminal illness.*
50. I have harmed myself physically. EG: Cut and or burned myself.*
Your SAFE Score is:
Probable Feelings and Behaviours Experienced:

Extemely High Mood - You are feeling peaceful, confident, motivated & in control of your life.
Probable Feelings and Behaviours Experienced
- Extemely High Mood - You are feeling peaceful, confident, motivated & in control of your life.
Probable Feelings and Behaviours Experienced:

Stable Happy Mood - You will be doing all your self-care routines and problem solving.

Suggested Solutions:

If the above statement does not feel accurate then re-do the questionnaire or consider watching the SAFE video to give you more emotional awareness. Start to investigate some mindfulness techniques and look at The Wise Mind Triangle to help bring your active mind into the present moment.
Probable Feelings and Behaviours Experienced.
- Good Stable Happy Mood - You will be doing all your self-care routines and problem solving.
Probable Feelings and Behaviours Experienced:

Just about Coping OK - Self-care can be a struggle - Relationships can be tense & strained - Possible Lack of Confidence - Uncertainty about the future.

Suggested Solutions:

Change your self care routines - Diet - Exercise - Reduce Alcohol Consumption. Read the S.A.F.E. model. Consider watching the S.A.F.E. model Video or joining a group zoom session.
Probable Feelings and Behaviours Experienced
- Coping OK - self-care can be a struggle - Relationships tense & strained - Lack of Confidence.
Probable Feelings and Behaviours Experienced:

Really Struggling to cope with life - Experiencing Stress at work and/or in personal relationships - Poor Appetite or Overeating - Increased Alcohol or Recreational Drug use - Loss of Confidence - High Levels of Anxiety - Lack of physical exercise - Tiredness - Lack of Concentration - Poor Memory

Suggested Solutions:

Make a GP appointment - Consider taking a break - Change your self care routines - Diet - Exercise - Reduce Alcohol Consumption - Read the S.A.F.E. model - Watch the S.A.F.E. model Video - Share your feelings with friends or loved ones - Consider engaging some talking therapy.
Probable Feelings and Behaviours Experienced
- Struggling to cope with life - Counselling support would be helpful - Group support helpful
Probable Feelings and Behaviours Experienced:

It feels desperate/in crisis - Possible Suicidal Ideation - Self Care Routines are poor - Lack of Sleep - Constantly Tired - Not Exercising - Weight Management Issues.

Suggested Solutions:

Make an Emergency GP appointment or Phone the Smaritans Free on 116 123. Counselling required. Consider watching my S.A.F.E. Model Video.
Probable Feelings and Behaviours Experienced
- It feels desperate/in crisis - Suicidal Ideation - Emergency GP appt or Counselling required.
Email me the Results (There is no charge for this service and your email will not be shared)
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Copyright 2012-2020 Jonathan Stubbs, Apollo Psychotherapy and Supervision.The S.A.F.E Psychotherapy Model has been created by Jonathan Stubbs
No part of this S.A.F.E Model may be re-produced in any way without the prior written permission of the author, Jonathan Stubbs.

SAFE Stress Questionnaire

Questions 40 - 50 require a Yes or No answer.

Extemely High Mood - You are feeling peaceful, confident, motivated & in control of your life.

Stable Happy Mood - You will be doing all your self-care routines and problem solving.

If the above statement does not feel accurate then re-do the questionnaire or consider watching the SAFE video to give you more emotional awareness. Start to investigate some mindfulness techniques and look at The Wise Mind Triangle to help bring your active mind into the present moment.

Just about Coping OK - Self-care can be a struggle - Relationships can be tense & strained - Possible Lack of Confidence - Uncertainty about the future.

Change your self care routines - Diet - Exercise - Reduce Alcohol Consumption. Read the S.A.F.E. model. Consider watching the S.A.F.E. model Video or joining a group zoom session.

Really Struggling to cope with life - Experiencing Stress at work and/or in personal relationships - Poor Appetite or Overeating - Increased Alcohol or Recreational Drug use - Loss of Confidence - High Levels of Anxiety - Lack of physical exercise - Tiredness - Lack of Concentration - Poor Memory

Make a GP appointment - Consider taking a break - Change your self care routines - Diet - Exercise - Reduce Alcohol Consumption - Read the S.A.F.E. model - Watch the S.A.F.E. model Video - Share your feelings with friends or loved ones - Consider engaging some talking therapy.

It feels desperate/in crisis - Possible Suicidal Ideation - Self Care Routines are poor - Lack of Sleep - Constantly Tired - Not Exercising - Weight Management Issues.

Make an Emergency GP appointment or Phone the Smaritans Free on 116 123. Counselling required. Consider watching my S.A.F.E. Model Video.