Stress and Afflictions

The adventuring life is not an easy one. Moving from town to town, delving into dark dungeons and hunting dangerous monsters for perhaps a few gold coins, is not a safe—or sane—way to make a living.
This article introduces mechanics to track a character's stress level and the lasting consequences these lingering, mental afflictions can have on their adventuring career.

Stress

Stress is a measure of pressure on a character's mental state, representing a build-up of negative emotions such as anger, fear, frustration, and irritation. Too much Stress is bad for your mental health and, if not treated carefully, can lead to detrimental Afflictions—or even death.
Characters can suffer up to 40 points of Stress before they reach breaking point. To prevent this, they'll need to find ways to relax and recover during downtime.

Gaining Stress

Stress is gained through danger, hardship, and adversity—suffering a critical hit from an enemy, hearing an unearthly moan from a dark room, sleeping rough in the cold rain, watching an ally die. Anything that threatens the mental well-being of your character can inflict Stress.
When choosing how much Stress to inflict, decide how significant the event is to the character—is it minor, moderate, major, or monstrous? The more emotionally significant, the higher the amount of Stress.
The more an event conflicts with the fundamental nature of your character, the greater the amount of Stress you'll suffer—a bard may be more embarrassed to ruin a performance than a wizard, while a lawful paladin is more hurt by a broken oath than a lawless rogue.

Category	Stress	Description
Minor	+1	A small frustration, worry, or irritant: missing an attack, falling down, hearing a noise in the dark.
Moderate	+2 1d4	You've made a critical error or something is seriously at risk: being caught lying, learning that the villain has escaped, being outnumbered.
Major	+4 1d6	Something devastating to your character or their beliefs: breaking an oath, falling to 0 hp, finding a heap of fresh corpses.
Monstrous	+8 1d6+4	Something incomprehensible or world-shattering: meeting a god, being betrayed by your closest friend, watching a loved one die.

CONSEQUENTIAL STRESS

You can gain Stress as a direct consequence of failing an action—missing an attack, breaking a lockpick, being caught in the middle of a lie. The KT will usually notify you that this is a risk before you make your attempt.
Here we see Syus Nightingale attempt—and fail—to pick a pick.

Syus: Ok, let's see what's in this chest. I want to pick the lock on this thing—what's the DC?

KT: It's a secure metal chest, so DC 20.

Syus: Easy. Lemme just... (rolls 15) ...ugh, fail.

KT: You hear the pins clicking in the lock, Syus, but you can't understand why they're not setting. It's a frustrating failure for you—gain 1 point of Stress.

Stress as a Consequence

Whether through a consequence or an explicit Stress check, a character should gain Stress only as a consequence for failing a roll of some kind—such as an attack roll, a defense roll, a skill check, or a Stress check.

STRESS CHECK

In cases where the environment or situation provokes an emotional response—standing before a dragon, entering a decrepit tomb, hearing a terrifying sound—you may be asked to pass a Stress check (Wisdom saving throw) to avoid gaining some Stress.
In this example, Jack McClain comes across a pile of rotting corpses of a few pack members and must pass a Stress check to keep his composure and avoid gaining Stress.

KT: You smell something foul, Jack. Behind the wooden door, you can hear a faint buzzing sound.

Jack: I open the door cautiously.

KT: Your torchlight illuminates a grisly scene—a dozen rotting corpses hidden in a small pantry, covered in a thick swarm of fat flies. The putrid stench of rotting flesh threatens to overwhelm you. Make a Stress check, DC 20.

Jack: I'm... (rolls 22) ...phew, ok.

KT: Horrifying though this is, you manage to retain your composure. Perhaps this isn't the first time you've seen a heap of rotting corpses?

Here we see Kěith Cheonsa as he returns to town from an adventure, only to discover that he has been betrayed by a trusted ally and his adopted son is in grave peril.
With his world turned upside down—and the town burning all around him—Kěith faces an almost impossible Stress check.

KT: Fire rages through the town. You hear a scream, Kěith, coming from the church. What do you do?

Kěith: Does it sound like Aubern?

KT: It does, yes.

Kěith: I shove past Jack and run through the burning streets, leaving him behind.

KT: As you pass through the burning archway of Granite Pearl, you see Aubern at the foot of the church steps. He is lying face down in a pool of blood. He isn't moving.

Atop the steps stands Beta Seán, a mad grin on his face and a bloodied dagger in his hands. "He's with the Bavara now, leech. No leech should have access to raising a pup."

Kěith: Vavheia damn it Seán, we trusted you!

KT: Your son lies dying, and your brother-in-law has betrayed you, Kěith. Make a Stress check, DC 30.

Kěith: That... (rolls 22) ...bastard.

KT: Your mind reels from this horrific turnabout, Kěith—gain 8 points of Stress.

_{Note* These are just examples. They don't have to be canon. Or do they?}

Snapping

Too much Stress can be unhealthy for your character, causing long-term problems. When your character gains 20, 30, and 35 points of Stress for the first time after a long rest, they snap and develop a mental Affliction.

KT: In a very surprising turn of events, Vince failed to smash open the chest with his headbutt. Vince, you gain 1 point of Stress.

Vince: These gods damned elven boxes. I'm up to 20 now—I've snapped. Time for a new Affliction...

Breaking Point

When a character gains 40 points of Stress, they hit breaking point. In this state, your character is reckless, dangerous, and extremely vulnerable.
If you are hit by a damaging attack while at breaking point, your character suffers a fatal heart attack. You fall to 0 hit points, fail any remaining death saving throws, and die immediately.

KT: The dragon lashes out at you, Jace, swinging its huge tail. Make a defense roll, DC 32.

Jace: I... (rolls a natural 1) ...ouch, take a critical hit.

KT: The dragon's tail slams into you without mercy. Take 26 points of damage and 2 points of Stress.

Jace: Damn, that puts me at 40 Stress.

KT: Your heart is pounding, Jace, and it's hard to breathe. You're not sure you can take another hit...

Stressful Situations

These are some example situations that might trigger Stress. Some characters may respond more strongly than others depending on their background—a fighter may be less stressed about being outnumbered in battle, while a necromancer might not react to the sight of a dead body.

• Badly failing an attack or skill check
• Hearing an unearthly roar from the dark
• Embarrassing yourself in front of someone
• Falling over or being knocked down
• Being disarmed or disabled
• Critically failing an attack or skill check
• Seeing a heap of mutilated corpses
• Facing a huge or formidable enemy
• Being caught lying
• Being surrounded, outnumbered, or out-flanked
• Being critically hit by an attack
• Seeing an ally die
• Accidentally hurting a friend
• Seeing a hideous abomination
• Breaking an oath
• Being betrayed by an ally

Healing Stress

Stress is healed through success and relaxation—disarming a trap, defeating a formidable opponent, carousing in town, sleeping in a warm bed. Anything that helps your character feel better can heal Stress.
The amount healed depends on the significance to your character. The more it aligns with your character's personality, the more you heal (at the GM's discretion)—rogues benefits more than mages from lockpicking, while clerics benefit more than fighters from prayer.

Category	Stress	Description
Minor	-1	A small success or bit of good news: disarming a trap, playing a song, relaxing with your friends.
Moderate	-2 1d4	A critical success or special achievement: eating a well-cooked meal, finding a hoard of treasure, repairing something important.
Major	-4 1d6	You've beaten the odds and gained a major victory: defeating a dangerous enemy, saving an ally from death, completing a work of art.
Majestic	-8 1d6+4	You've achieved a long-term goal or done something thought near impossible: bringing a friend back from death, finishing a masterpiece, receiving praise from your deity.

Here we see Clanda attempt to disarm a magical trap with her arcane training, healing Stress in the process. As a sorceress disarming a magical trap, she heals a moderate amount of Stress instead of a minor amount.

KT: The runes are glowing brighter, and you feel static building in the air. If you don't act quick, Vince, this trap will explode.

Vince: Pfft, this is amateur work—dwarven runes are so basic. I'll try to dispel the binding rune to disarm the trap harmlessly.

Jace: Uh, are you sure about that? Last time—

Vince: Hush now, I'm working.

KT: Ok, that'll be a DC 20 Wisdom check. You can use Arcana with this.

Vince: See I told you, Jace... (rolls 24) ...I got this.

KT: You manage to locate the binding rune and, with a careful words, draw the magick out of it. With a harmless spark, the runic trap shatters. Vince, you heal 2 points of Stress—everyone else heals 1.

Vince: Excellent. You're welcome, everyone.

It is much harder to heal Stress than it is to gain it, so you'll need to be proactive in treating your Stress level before it becomes insurmountable. Rest when you can, and try not to over-exert yourself.

DOWNTIME

While out travelling, a good time to heal Stress is during downtime and through sleep. Here, Mason takes advantage of his downtime during a night's rest to meditate and clear his mind.

KT: Ok, while Kěith's resting for the night. What do you all do for the next few hours?

Mason: I spend a couple of hours meditating.

KT: Ok—it's been an easy day, so make a DC 10 Wisdom check.

Mason: No problem... (rolls 17).

KT: You're able to calm your mind and organize your thoughts, Mason. Heal 2 points of Stress.

TAKING A LONG REST

When you complete a long rest in a sanctuary, such as a village, town, or city, you heal all stress. Reduce your Stress level to 0.

Returning to the Winter Moon Pack, Jack takes a long rest and begins a week of training. Once the week is over, he reduces his Stress to 0.

CALM EMOTIONS

When you are affected by the Calm Emotions spell—or other similar magick spells and effects—you heal a moderate amount of Stress.

Stress Relief

These are some things a character might do to reduce their stress levels. Not everyone will recover in the same way—an introvert may unwind best on their own with a good book and some hot tea, while an extrovert may want to throw a raucous and extravagant party to blow off steam.

• Disarming a trap
• Defeating a dangerous enemy
• Eating a hot, well-cooked meal
• Making people laugh with a joke
• Listening to a bard perform a song
• Carousing in a rowdy tavern
• Picking a lock
• Sleeping in a warm, comfortable bed
• Praying to your deity
• Finding a chest of treasure
• Arriving somewhere safely after a long journey
• Spending time with family and friends
• Learning a new skill
• Engaging in a hobby
• Playing with a pet
• Rolling dice and playing some games
• Fulfilling an oath or promise
• Protecting an ally from harm
• Meditating and resting
• Making a discovery

Afflictions

An Affliction is a stress-induced mental issue suffered by a character when they gain too much Stress. Afflictions affect your character's abilities and can only be cured during downtime.
When you gain 20, 30, and 35 Stress for the first time after a long rest, roll on the Afflictions table to see which new mental Affliction you develop. If you roll a duplicate, roll again until you get a new result.
Afflications and their Modifiers

1d100	Afflication	Modifier
1-6	Fearful	Disadvantage on WIS checks & saves
7-12	Lethargic	+1 exhaustion until removed
13-18	Masochistic	Disadvantage on CON checks & saves
19-24	Irrational	Disadvantage on INT checks & saves
25-30	Paranoid	Speed is halved
31-36	Selfish	Disadvantage on CHA checks & saves
37-42	Panic	Disadvantage on DEX checks & saves
43-48	Hopelessness	Disadvantage on STR checks & saves
49-54	Mania	Disadvantage on attack rolls
55-60	Anxiety	Disadvantage on Stress checks
61-66	Hypochondria	Hit point maximum is halved
67-72	Narcissistic	Disadvantage on ability checks
73-77	Powerful	+2 to all damage rolls
78-82	Focused	+2 to all attack rolls
83-87	Stalwart	+2 AC
88-91	Acute	Advantage on INT checks & saves
92-96	Perceptive	Advantage on WIS checks & saves
96-100	Courageous	Advantage on CHA checks & saves

KT: Jack, you hear a sickly moan from the shadows. Make a DC 10 Wisdom saving throw to see if you can keep your composure.

Jack: Sure... (rolls 6) ...damn, not enough.

KT: Gain 1 point of Stress, Jack.

Jack: That pushes me over 20—looks like I'm feeling pretty... (rolls 41) ...panicked. How appropriate.

Curing Afflictions

Afflictions don't go away on their own—your character must dedicate time to treating their mental state. During a long rest, your character can attempt to treat one of their Afflictions in an appropriate fashion—carousing, praying, resting, meditating, etc.
Spend some gold to roll a d20 to make an Affliction Removal attempt. Some downtime activities, such as resting, may allow you to roll with advantage—bear this in mind if your Afflictions are proving hard to clear, before you become overwhelmed by them.
Affliction Removal

1d20	Result
1	Critical Failure: You fail to cure your Affliction, gaining a new one in the process.
2-9	Failure: You fail to cure your Affliction.
10-19	Success: You cured your Affliction.
20	Critical Success: In a moment of clarity, you cleared yourself of all Afflictions and Stress. You can only make one Affliction Removal attempt per in-game week, so make the best of it.

COSTS

As you gain in experience, it becomes harder to reset your mental state—the things you have seen and experienced have had a lasting impact. It costs more to remove an Affliction the higher your level as you must seek more elite and exotic outlets.
Affliction Removal Costs

Level	Money
1	5
2	7
3	9
4	12
5	16
6	22
7	30
8	42
9	58
10	81
11	113
12	158
13	221
14	309
15	432
16	604
17	845
18	1,183
19	1,656
20	2,318

GREATER RESTORATION

The Greater Restoration spell may be used to let you make an Affliction Removal attempt outside of a long rest. This counts as your once-per-week removal attempt.
From levels 1-10, you may roll your Affliction Removal check with advantage when using Greater Restoration. From levels 11-20 however, roll with disadvantage.

Mental Breakdown

If your character gains more than 3 Afflictions, they suffer a complete mental breakdown—your character falls catatonic and must be committed into care or die.
A character who has had a breakdown can no longer be played—treat them as if they have retired.

RECOVERY

If a character is placed in good care, there is a rare chance they may eventually recover from their breakdown. For each month of proper care, they may roll an Affliction Removal attempt with disadvantage. A month after they have removed all Afflictions, they recover their senses and can be active again.
Each time a character recovers from a breakdown, their minimum Stress increases by 10.

Items & Consumables

Across your adventures, you may be able to buy, craft, or loot special items that can help you to manage stress—magic gear, soothing teas, precious potions, etc.
Items & Consumables

Soothing Stones

Wondrous Item

Varies small

A pair of small, stone balls engraved with dwarven runes. They make a soothing sound when held in one hand.

Relaxing Sound: During camp, if you successfully Relax in Solitude, you heal an additional +1 Stress.

Elixir of Sanity

Potion

Varies consumable

This thick purple elixir looks almost alive. When you stare at it, you get the feeling you're being watched.

Iron Soul: When you drink this elixir, you may roll any Stress checks with advantage for one hour.

Ring of Clarity

Ring

Rare small

This fine silver ring, forged by the elven monks of Vash'gir, is set with a tiny astral topaz.

Clear Mind: When you wear this ring, you can increase your maximum stress by +8.

Book of Sermons

Wondrous Item

Common small

A cheap but illustrated book of inspiring sermons.

Sermon: During camp, you can attempt to read a sermon from the book. If you successfully Tell a Story, you heal an additional +1 Stress.

Greenleaf Tea

Wondrous Item

Common small

A packet of faun tea leaves. One packet contains enough leaves for five separate brews.

Delicious Tea: If you successfully Brew Drinks using one charge of tea leaves, each person who takes a drink can heal an additional +1 Stress.

Variant Dials

Stress & Afflictions is a flexible game mechanic that can be adjusted to suit a variety of settings and gameplay styles. If you want to customize the experience for your game, consider using some of these variant dials.

A: One Snap

If you want to make afflictions a little rarer in your game—or prevent rapid escalation once a character reaches 50% stress—consider this One Snap variant.
The first time you gain 50% or more Stress after a long rest, you snap and develop a mental Affliction. You can only snap once per long rest, though you still risk hitting your breaking point if you reach 100% Stress.

B: Insanity Zones

You may want to use Stress & Afflictions for just a short time in your campaign—to add theming to a particular region or adventuring site, for example. You can achieve this with insanity zones.

CREATING AN INSANITY ZONE

Stress is only gained in certain areas—insanity zones. Outside of these zones, characters don't gain stress—though they still suffer the effect of any lasting afflictions.
An insanity zone can be anything—a room, a dungeon, a kingdom, etc—so add them to your game as best suits your setting. Use them to add memorable features to your dungeons and adventure hubs.

Vince and Jace approach the Cave of the Shadow Queen, an ancient dungeon corrupted by aberrant powers. The tomb is an insanity zone—within its walls, players risk gaining stress.

LEAVING AN INSANITY ZONE

If you leave an insanity zone, your stress and afflictions remain until you complete a long rest (or perform another form of recovery action, such as spending hit dice or acquiring consumables).

C: Temporary Virtues

Some afflictions—such as Powerful and Focused—can be a benefit to your character. With this Temporary Virtues variant, these effects become short-lived.
If you develop a beneficial affliction, it is automatically cured without cost at the end of your next long rest.

D: Restful Recovery

If you are running an episodic game and need to drastically limit the running scope of stress and afflictions, consider using this Restful Recovery variant.
When you complete a long rest in a sanctuary, you automatically recover all stress and cure all afflictions.

Getting Started with Stress

If you want to try using Stress & Afflictions in your games without overhauling your campaign, consider starting with the monstrous attacks, insanity zones, and one snap variants.
These dials can limit the scope of the stress mechanic and help you to slowly introduce the rules to your players.

E: Stressful Attacks

If you want to disconnect Stress from abstract failure, consider instead attaching stress to monsters and traps with Stressful Attacks.
Give your monsters and traps attacks that deal stress damage instead of—or in addition to—hit point damage. These stressful attacks can be a very effective way to add flavor to your aberrant and psychic monsters—especially those that use fear and intimidation powers.
Monsters and Traps that deal Stress

Gibbering Horror CR: 5 (1,800 XP)

Medium aberration, neutral

Armor Class: 14

Hit Points: 138 5d8+6

Speed: 30 ft

STR

12 +1

DEX

11 +0

CON

13 +1

INT

8 -1

WIS

12 +1

CHA

9 -1

Saving Throws: Con +6 , Str +3 , Dex +0

Skills: Acrobatics +5 , Perception +2 , Stealth +2

Condition Immunities: prone

Senses: Darkvision 60 ft., passive Perception 10

Challenge Rating: 5 (1,800 XP)

Actions

Bite. Melee Weapon Attack: +5, reach 5 ft., one target. Hit: 8 piercing damage.
Mad Gibbering. Melee Weapon Attack: +13, reach 5 ft., one target. Hit: The target gains 2 1d4 points of Stress.

Screaming Skull

Weapon

Varies

When a visible creature steps within 5 ft of the skull, it unleashes a piercing scream that chills the heart of everyone within 15 ft. Then, it shatters.

Attack: DC 15 vs Intelligence.

Hit: The target gains 2 1d4 points of Stress.

F: Leveling Stress

As you gain power and knowledge, your ability to handle stress also improves. With Leveling Stress, your stress limits and snapping points are influenced by your character level and intelligence modifier.
Calculate your maximum stress and snapping points as follows, rounding down when necessary:

Leveling Stress

Maximum Stress: 20 + level + (4 x INT)

Snapping Points: 50% / 75% / 87.5%

MINIMUM STRESS

Your baseline maximum stress as calculated here can't go below 16, regardless of your intelligence modifier.

GAINING STRESS

When using this variant, be mindful of how much Stress you deal to low-level characters. A 1st-level character with −1 INT has only 17 maximum stress and snaps at 8/12/14 points of stress—a very short fuse indeed.
Try to limit yourself to minor and moderate stress checks where appropriate at lower levels, and reserve major/monstrous for the most extreme of situations at higher tiers of gameplay.

G: Light & Shadow

If you are using the Light & Shadow rules and want visibility to be an even bigger threat to your players, consider this variant.
If you are blinded, you are vulnerable to stress—you gain twice the amount of stress as you normal would.

H: Indefinite Madness

If you don't want characters in your game to die outright when they are at breaking point, consider afflicting them with Indefinite Madness instead.
If you are hit by a damaging attack while at breaking point (100% Stress), you fall unconscious. No amount of jostling or damage can wake you.
After 2d4 hours, you awaken with an indefinite madness—roll on the Indefinite Madness table to see what you are afflicted with.

I: Slow Recovery

If you want to make it harder for characters to recover from Stress, then consider this Slow Recovery variant.
Anytime you would heal Stress, reduce the amount healed by half (don't round this halved amount).
Valiant heals a minor (1) amount of Stress from his daily prayer. Because of Slow Recovery, however, he instead heals only 0.5 Stress.