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Svetlana Masgutova Educational Institute

The Masgutova Neurosensorimotor Reflex Integration - MNRI® Method

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Masgutova Stress Resiliency Questionnaire

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Welcome to the Masgutova Stress Resiliency Questionnaire.

This questionnaire was designed by Dr. Svetlana Masgutova in order to help measure an individual's stress resiliency capabilities. When completing this questionnaire, please report on the stress response when dealing with stress beyond the everyday stressor. Stress that is intense, more extreme, or a severe stressor.

The Masgutova Foundation invites you to repeat this questionnaire at 1, 3, 6, 9, and 12 month intervals, so you may monitor your stress resiliency. In order to facilitate this comparison, you may print your results at the end of the survey. Please note that this questionnaire is part of ongoing research and program development by Dr. Masgutova and the Masgutova Foundation.

Please create a User ID using the first letter of each word in your name and your birthday formatted as MMDDYY.
Example: Jon Paul Doe, April 10, 1975 = User ID: JPD041075
If you are completing for someone else, please use their name and birthday.
If you have previously been assigned a User ID, continue to use that ID.

Enter your User ID:*

I am completing the questionnaire for:* Myself A child or adult in need

Select gender:* Male Female No Answer

Select date of birth:*

Occupation:*

If you have a medical, psychological, or developmental diagnosis, please check all that apply here: Agenesis of the Corpus Callosum Allergies ALS Anxiety Asthma Attachment Disorder Attention Deficit Disorder Attention Deficit Hyperactivity Disorder Auditory Processing Disorder Autism Spectrum Disorder Auto Immune Disorder (Please describe below) Bladder Issues Cancer Cerebral Palsy Chronic Pain Cognitive Impairment Concussion Depression Diabetes Down Syndrome Dyspraxia/Apraxia Dyslexia (SLD) Eating Disorder Edwards Syndrome Epilepsy Genetic Disorder (Please describe below) Hearing Impairment Heart Diagnosis, Blood Pressure High Risk for Post Traumatic Stress Disorder Hypoglycemia Hypotonia Insomnia Jaundice/Liver Disease Learning Disability Migraines Multiple Sclerosis Neurological Disorder Obsessive Compulsive Disorder Oppositional Defiance Disorder Paralysis (Please describe below) Parkinsons Post Traumatic Stress Disorder Prader Willie Syndrome Reflex Integration Disorder Rett Syndrome Schizophrenia Sensory Processing Disorder Stroke Tourettes Syndrome Traumatic Brain Injury Visual Impairment Other (Please describe below)

Please add additional diagnosis and description:

Please provide your MOST IMMEDIATE response for the following questions when you are IN INTENSE/EXTREME STRESS (beyond everyday stress)

My body trembles (internally or externally):* Always Usually Seldom Never I do not know

Please Describe:

I find it difficult to make decisions:* Always Usually Seldom Never I do not know

It is difficult to imagine myself in the future when I am stressed:* Always Usually Seldom Never I do not know

I become more impulsive:* Always Usually Seldom Never I do not know

Stress does not affect my emotions for extended periods of time:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

My body temperature changes:* Always Usually Seldom Never I do not know

I control my behavior well:* Always Usually Seldom Never I do not know

I know today's stress will pass (Example: "I can work through it"):* Always Usually Seldom Never I do not know

I have a physical response to stress (Examples: feel hot/cold; skin is pale or red; internal pressure; hands/feet/body are sweaty):* Always Usually Seldom Never I do not know

I lose my confidence in my ability to work/study:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I act rough (Examples: angry/cross/too direct):* Always Usually Seldom Never I do not know

Please Describe:

I lose my motivation:* Always Usually Seldom Never I do not know

My response time changes (Examples: Slows down/becomes impulsive):* Always Usually Seldom Never I do not know

Please Describe:

IN STRESS (*beyond everyday stress)

I make mistakes in my work:* Always Usually Seldom Never I do not know

I become overly emotional:* Always Usually Seldom Never I do not know

My attitude toward the world (people and life) around me is affected:* Always Usually Seldom Never I do not know

My elimination functions (bowel/bladder) are usually affected:* Always Usually Seldom Never I do not know

Please Describe:

IN STRESS (*beyond everyday stress)

The quality of my voice changes (Examples: volume control or trembling voice):* Always Usually Seldom Never I do not know

Please Describe:

My thoughts become clearer:* Always Usually Seldom Never I do not know

I am able to see the positive things that can come from my stress:* Always Usually Seldom Never I do not know

I retain memories of being stressed for long periods of time:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I am able to maintain an inner peace:* Always Usually Seldom Never I do not know

My stress today can ruin my future:* Always Usually Seldom Never I do not know

The quality of my work/studies becomes less effective:* Always Usually Seldom Never I do not know

Stress spoils my mood for extended periods of time (Examples: days/weeks/months):* Always Usually Seldom Never I do not know

Please Describe:

IN STRESS (*beyond everyday stress)

I am organized in stress:* Always Usually Seldom Never I do not know

My body/muscles become tense:* Always Usually Seldom Never I do not know

I feel the desire to start conflicts:* Always Usually Seldom Never I do not know

I become short of breath:* Always Usually Seldom Never I do not know

I manage stress easily:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

My emotions become more negative:* Always Usually Seldom Never I do not know

It is difficult to focus:* Always Usually Seldom Never I do not know

My body is able to overcome stress easily:* Always Usually Seldom Never I do not know

Stress interferes with my ability to communicate (Examples: communication with others, communication within close relationships):* Always Usually Seldom Never I do not know

My skin feels more sensitive (Examples: temperature, pain, light, touch):* Always Usually Seldom Never I do not know

Please Describe:

IN STRESS (*beyond everyday stress)

I blame others for my stress:* Always Usually Seldom Never I do not know

I go into a freeze response (Examples: "I become immobilized" or "frozen with shock or fear"):* Always Usually Seldom Never I do not know

My motor coordination is negatively affected:* Always Usually Seldom Never I do not know

My diet changes (Examples: I eat too much/I stop eating):* Always Usually Seldom Never I do not know

Please Describe:

Stress pushes me to reach for my goals:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

My taste preferences change:* Always Usually Seldom Never I do not know

My vision serves me well (Examples: "my visual attention allows me to see all around, both things and events"):* Always Usually Seldom Never I do not know

I lose my ability to hear well:* Always Usually Seldom Never I do not know

I lose my patience (Examples: easily irritated):* Always Usually Seldom Never I do not know

I lose my balance easily:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I am startled by unexpected flashing light:* Always Usually Seldom Never I do not know

I have a good memory:* Always Usually Seldom Never I do not know

It is easy to imagine my future:* Always Usually Seldom Never I do not know

Stress interferes with the way I communicate within relationships:* Always Usually Seldom Never I do not know

It is difficult to forgive the person that has caused my stress:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I make good decisions:* Always Usually Seldom Never I do not know

I do my best to protect others from stress:* Always Usually Seldom Never I do not know

I become irrational:* Always Usually Seldom Never I do not know

It is difficult to use my vision properly (Examples: "it is difficult to focus with my vision/it is difficult to see all objects and events clearly"):* Always Usually Seldom Never I do not know

I retain my confidence:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

It is difficult for me to attend to a task in a busy environment (Examples: too loud, too many competing sounds, too many people):* Always Usually Seldom Never I do not know

Please Describe:

I feel depressed when I am stressed:* Always Usually Seldom Never I do not know

I feel overwhelmed when trying to remember things:* Always Usually Seldom Never I do not know

It is difficult to control my actions:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I go into a flight/flee response (Examples: "I feel the need to get away or flee"):* Always Usually Seldom Never I do not know

I can easily filter out unimportant information in order to attend to a task:* Always Usually Seldom Never I do not know

My sleep is affected:* Always Usually Seldom Never I do not know

Please Describe:

My relationships with others are affected:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

My heart races:* Always Usually Seldom Never I do not know

My sense of smell changes (Examples: some smells irritate me, I stop noticing some of them):* Always Usually Seldom Never I do not know

Please Describe:

I am startled easily when I am touched unexpectedly:* Always Usually Seldom Never I do not know

I do not care about my relationships:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

My skin color changes (Examples: I become pale/I become red):* Always Usually Seldom Never I do not know

Please Describe:

I easily regress in my behavior (Examples: Can act childish/less mature/immature for age):* Always Usually Seldom Never I do not know

Please Describe:

It is hard for me to control my stressed state (Examples: controlling my arousal, my fearfulness):* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I blame myself for my stress:* Always Usually Seldom Never I do not know

I slow down in my work/studies:* Always Usually Seldom Never I do not know

I feel the need to stay strong:* Always Usually Seldom Never I do not know

It is difficult to think about my future when I am stressed:* Always Usually Seldom Never I do not know

I can separate my work/studies from stress:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I am more productive than usual:* Always Usually Seldom Never I do not know

I have good focus:* Always Usually Seldom Never I do not know

My body is able to release physical tension easily within 15/20 minutes of becoming stressed:* Always Usually Seldom Never I do not know

It is difficult to follow instructions:* Always Usually Seldom Never I do not know

I am able to maintain good balance:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I go into a fight response (Examples: "I feel hyper aroused, ready for action, cross, or aggressive"):* Always Usually Seldom Never I do not know

I lose hope easily when I am stressed:* Always Usually Seldom Never I do not know

I can get sick more frequently when I am stressed:* Always Usually Seldom Never I do not know

My eyesight does not work well (Example: "I do not see sharply"):* Always Usually Seldom Never I do not know

I am less sensitive to pain:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

My digestive system is affected:* Always Usually Seldom Never I do not know

I am startled easily by sounds:* Always Usually Seldom Never I do not know

I become speechless (Example: "I do not know what to say"):* Always Usually Seldom Never I do not know

I do not feel safe in dark spaces:* Always Usually Seldom Never I do not know

I prefer to sleep with a light on:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

I keep an enthusiastic mood when I am stressed:* Always Usually Seldom Never I do not know

I lose my confidence in myself:* Always Usually Seldom Never I do not know

I become stubborn:* Always Usually Seldom Never I do not know

I am outwardly overly emotional (Examples: scream, shout, cry):* Always Usually Seldom Never I do not know

Please Describe:

I communicate well:* Always Usually Seldom Never I do not know

IN STRESS (*beyond everyday stress)

It is difficult to focus on my work/studies:* Always Usually Seldom Never I do not know

I approach my work/study in a disorganized way (Examples: too fast and chaotic):* Always Usually Seldom Never I do not know

I am poor at multitasking:* Always Usually Seldom Never I do not know

It becomes difficult to think of alternative solutions to problems:* Always Usually Seldom Never I do not know

Stress causes me to think of my past failures:* Always Usually Seldom Never I do not know

In your own words, how does stress affect you?*

Describe the things that give you the greatest stress:*

On a scale of 1-10, how stressed do you feel today? 1 = Not stressed at all and 10 = Very stressed:*

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