Rules Variant: Stress Mechanics

Download a pdf of this rules variant here.

Adventuring is a challenging profession. It does not just test a person physically, but also mentally and emotionally.

The material presented here provides optional rules for introducing a stress mechanic into your game. Stress operates as a mental and emotional counterpart to the already existing exhaustion mechanics.


Some special abilities and events, such as dropping to 0 hit points, can lead to a special condition called stress. Stress is measured in six levels. An effect can give a creature one or more levels of stress, as specified in the effect’s description.

Level      Effect

1       Disadvantage on Intelligence, Wisdom, and Charisma ability checks

2       Disadvantage on Intelligence, Wisdom, and Charisma saving throws

3       Can only make one attack per turn, regardless of class features or magical effects. Disadvantage on saves to maintain Concentration.

4       Can take an Action or a Bonus Action, but not both. Cannot take reactions.

5       Incapacitated

6       Random permanent madness

If an already stressed creature suffers another effect that causes stress, its current level of stress increases by the amount specified in the effect’s description.

A creature suffers the effect of its current level of stress as well as all lower levels. For example, a creature suffering level 2 stress has disadvantage on Intelligence, Wisdom, and Charisma ability checks and saving throws.

An effect that removes stress reduces its level as specified in the effect’s description, with all stress effects ending if a creature’s stress level is reduced below 1.

Finishing a long rest reduces a creature’s stress level by 1, provided that the creature has also ingested some food and drink.

Events that Cause Stress

The following are examples of the types of events that could result in a creature gaining stress.

  • Dropping to 0 hit points causes 1 level of stress.
  • Critically failing an Intelligence, Wisdom, and Charisma saving throws causes 1 level of stress.
  • Witnessing the death of an ally causes 1 level of stress.

Stress in a Fantasy Horror Game

In a dark fantasy, horror-themed game, stress is more likely to occur. In particular, aberrations, undead, and magic are sources of stress. Consider adding these possibilities as events that cause stress.

  • Critically failing on a spell attack roll causes 1 level of stress.
  • Being critically hit by an attack that deals psychic damage causes 1 level of stress.
  • Gaining the frightened condition causes 1 level of stress.
  • When an aberration or undead is encountered, the character must make a Wisdom saving throw (DC 8 + the CR of the creature) or gain 1 level of stress. Failing by 5 or more gives 2 levels of stress.

Other Sources of Stress

The DM might decide that an event, environment, or situation that a character finds themself in is particularly stressful. In this case, they might call for a Wisdom saving throw, with 1 level of stress gained on a failure.

The DM should set the DC based on how stressful the situation is. Particularly stressful occasions might even cause more than 1 level of stress.

Variant: More Persistent Stress

If you want stress to be a bigger challenge to your players, you can place more restrictions on removing a level of stress.

Removing a level of stress might require a long rest and hot meal in an inn, tavern, or other safe, indoor place. Or it might require a day of downtime spent doing relaxing activities. This can be an opportunity for role-playing what the characters find calming when not out on a quest.

With the persistent stress option, stress will slowly accumulate for the characters over the course of a quest, adding a ticking clock — can the party complete the quest before they succumb to stress and madness?