SELF ASSESSMENT
Select all that apply for each question.
QUESTION 1 — Anxiety / Panic 🔴 Red
Which of these feels closest to you right now?
- Sudden fear or dread
- Breath feels tight or fast
- Thoughts spiralling or racing
- Shaking, trembling or feeling out of control
- None of these feel true for me.
Intensity: How strong is this feeling right now?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 2 — Stress / Overwhelm 🟠Amber
Are you experiencing any of these?
- Everything feels too much
- Pressure building with no release
- Irritable or snapping quickly
- Hard to focus on anything
- None of these feel true for me.
Intensity: How overwhelming does this feel?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 3 — Sadness / Depression 🟤 Smokey Taupe
Do any of these describe your mood?
- Heaviness in your body or mind
- Loss of interest or motivation
- Numbness instead of sadness
- Feeling slowed down inside
- None of these feel true for me.
Intensity: How heavy does this feel?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 4 — Loneliness / Disconnection 🔵 Blue
Are you experiencing any of these?
- Disconnected from people
- Emotionally flat
- Hard to reach out
- Feeling far away from yourself
- None of these feel true for me.
Intensity: How isolated do you feel?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 5 — Overthinking / Rumination 🟡 Yellow
Where is your mind sitting right now?
- Looping thoughts
- Worrying about the same thing repeatedly
- Searching for answers without finding peace
- Difficulty quieting your mind
- None of these feel true for me.
Intensity: How stuck in your thoughts are you?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 6 — Trauma Activation 🔴 Deep Red
Do any of these sensations match you?
- Your body remembers something before your mind does
- Sudden emotional flooding
- Startle or freeze responses
- Feeling unsafe for no clear reason
- None of these feel true for me.
Intensity: How activated does your body feel?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 7 — Anger / Irritability 🟠Burnt Orange
Which describes your state right now?
- Anger rising fast
- Sharp irritation
- Hard to calm down when triggered
- Body feeling hot or tense
- None of these feel true for me.
Intensity: How intense is this anger/irritation?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 8 — Grief / Bereavement 🟣 Deep Rose
Are you experiencing any of these?
- An ache in your chest or stomach
- Missing someone intensely
- Heavy waves of emotion
- Sudden sadness that comes and goes
- None of these feel true for me.
Intensity: How deep is this grief?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 9 — Fatigue / Burnout 🟤 Earthy Brown
Which feels true for you?
- Exhaustion that rest does not fix
- Feeling drained or empty
- Struggling to begin tasks
- Carrying too much for too long
- None of these feel true for me.
Intensity: How depleted do you feel?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 10 — Low Motivation / Emotional Flatness 🟤 Mid-Tone Taupe
Are you noticing any of these?
- Difficulty starting even small things
- Feeling emotionally muted
- Low drive or spark
- Not caring about things you normally would
- None of these feel true for me.
Intensity: How flat or disconnected do you feel?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 11 — Feeling Helpless or Stuck 🟣 Muted Purple
Which of these resonates most?
- Feeling stuck in place
- Hard to see a way forward
- Feeling smaller or powerless
- Unsure what to do next
- None of these feel true for me.
Intensity: How stuck or powerless do you feel?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 12 — Physical State 🟢 Green
How is your body feeling right now?
- Tension, tightness, or pain
- Restless energy needing movement
- Heavy, sluggish, or disconnected
- Calm and grounded
- None of these feel true for me.
Intensity: How noticeable are these physical sensations?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe
QUESTION 13 — Sleep & Rest 🟣 Deep Purple
How has your sleep been recently?
- Racing mind when trying to sleep
- Waking frequently or too early
- Sleeping too much but still tired
- Nightmares or disturbing dreams
- None of these feel true for me.
Intensity: How much is this affecting your daily life?
🟢 Minimal | 🟡 Mild | 🟠Moderate | 🟤 Significant | 🔴 Severe