I am little bit afraid while posting my views on this question as my earlier answer initially attracted four likes and latter four dislikes.

However, I still hold the view that it is difficult to select a better instrument to measure stress unless we are clear how we are defining the stress- either in terms of the basic processes involved or in terms of its product such as level of cortisol. Many of the posts cast doubt that level of cortisol may not prove to be a valid indicator of the stress and some advocate its use.

According to me the best measure of stress should constitute a measure of such outcome (be it physiological or psychological) which is solely (or at least largely) altered by the level of stress. To my knowledge such indicators are not available till date and thus we have to make a compromise with how much measurement error we are willing to allow. The best way in my view will be to use multiple methods and indicators of stress.

1) The Stress Arousal Checklist (SACL; Mackay, Cox, Burrows, &

Lazzerini, 1978)

2) Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983)

We use the PHQ9 (Depression) and GAD7 (anxiety) for brief self-reported distress

measures. But when attempting to maximize accuracy, we use our own Spouse/Friend Rating Scale - The Ketterer Stress Symptom Frequency Checklist.

I agree, Perceived Stress Scale

It is q very complicate question. you need a composite index using psy chological and biological assessments. all articles from Mc Ewen about allostatic lozd can help you.

I agree, psychological, behavioral and biological alterations occur during stress and could be detected using different instrements depends upon what factors you are going to measure.

I agree / Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983)

Do not have any doubt: The Perceived Stress Scale is one of the best available questionnaire, is short, and the only available with evidence on biological correlates of their measure. See this paper from Elizabeth H. Blackburn, Nobel Prize: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC534658/?rendertype=abstract

Dear Mette, it depends whether you aim to measure stress as a response or as a transaction with the work environment, i.e. work-related stressful factors as perceived by job incumbents. In the former case, you can rely upon measures proposed by the colleagues above, in the latter you may wish to use instruments that are purported to assess whether psychosocial working conditions are appraised by the workers as being more o less stressful or supportive to them. Please refer if you like to the famous COPSOQ questionnaire (Kristensen TS, Hannerz H, Høgh A, Borg V. The Copenhagen Psychosocial Questionnaire (COPSOQ). A tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health 2005;31:438-449), you are quite lucky here since it has been developed in Denmark by the National Institute of Working Life, it is psychometrically very strong and it also provides normative data. Hope this helps you.

Paul

Hello,

depends of your needs... for occupational settings, I use the Osipow Occupational Stress Indicator-revised

...and it's user-free!

Paul

Depending on the Country :)... not in France... you will have to check for Denmark

I would also recommend the PSS, but if you are also interested in symptoms of depression and/or anxiety, the DASS (Depression Anxiety Stress Scales) might be an option.

I am happy to hear that u have been working in Stress. We have developed and validated a tool for assessing stress. Before that kindly tell who is your respondents? contact me furhtr in mail. i will forwrd the tool

I would prefer an instrument that has been validated against 1) biological stress symptoms 2) cortisol levels (eg measured by hair samples - or if that is not possible, by saliva) or 3) neurological changes....

I have found this comparison of stress scales: http://iscrr.com.au/media/38388/Report_Workplace_Stress_Evaluation_Tools_1111.pdf

The Holme's scale is broad but good for identification of stressors.

I agree with the view of Thomas Kantermann that one should think of the definition of the stress before trying to chose a measure of it.

Form the various responses of the esteemed members it appears that many of them suggest to use a measure that samples the perceived level of stress while a few also suggest to add response based measures of stress that includes items measuring anxiety, depression etc.

However, I personally see problem with both. The perceived level of stress may not actually reflect the actual level of stress an individual is going through. I would like to share my own experience while we were involved in developing a measure of Psychosocial stress. This scale asked respondents to report how frequently and how much they experience stress in different psychosocial domains such as interpersonal relationship, social responsibilities/liabilities, health and finance etc. (each domain included several items dealing with different aspects of each). What we observed that on a 4-point scale of frequency and intensity of stress most of the respondents reported lower level of perceived stress. And this trend was visible even in those who in fact reported a lot of issues about which they are constantly worrying and they scored high on response measures of stress such as frequency of psychosomatic symptoms, anxiety etc.

Such observations suggest that people frequently exposed to wide range of stressors in day to day living, perhaps have developed a higher threshold of tolerance and as a result they report or perceive stress lower than the actual.

If we choose to use response based measures of stress that assesses the various types of strains or outcomes of stress then again we are bound to face some difficulties in arriving at an accurate estimate of experienced stress. First, anxiety, depression and similar indicators of stress are not the sole outcome of stress. They may occur because of several other factors including biological and biochemical anomalies. Sometime they may occur elusively because of factors other than stress. Secondly, such stress measures substantially overlap with the measures of mental health and thus pose a difficulty for developing the nomologic network of the construct of stress distinct from its health outcomes.

Even if we use pure biological indicators of stress, it is likely that 'repressors' would report no or little subjective experience of stress even if the biological markers suggest the reverse.

Thus, Thomas Kantermann statement seems quite reasonable and logical and suggest a need to re-conceptualize stress in operational terms.

There is also a need to focus on what type and what level of stress really needs to be managed. When it is functional and when it becomes dysfunctional. Dealing with the latter issue puts a need to consider such positive factors as resilience, thriving, post-traumatic growth etc.

Thank you Mette for the oquestion and everybady for answres. I also took advantage of the answers.

Hi all

Have seen the Maslach stress inventory used extensively. It is fairly dated but very valid, however it would depend on how you are conceptualizing stress and what exactly you ant to meaure. You may have to apply two tools

Regards Eileen

Hi there,

depending on who is taking the test, there are different ones to chose from.

here is one for migrants or internationals/ expatriates who moved to denmark. It is specified as acculturation stress:

Berry, J.W. (2006). Stress perspectives on acculturation. In D.L. Sam & J.W. Berry (Eds.), The Cambridge handbook of acculturation psychology (pp. 43–57). Cambridge, United Kingdom: Cambridge University Press.

Validating the Riverside Acculturation Stress Inventory with Asian Americans.

Miller, Matthew J.; Kim, Jungeun; Benet-Martínez, Verónica

Psychological Assessment, Vol 23(2), Jun 2011, 300-310.

in animal ..for example to measure anxiety you can use OFT .. but in human you can use Depression Anxiety Stress Scale-21 (DASS-21) (so you measure three parameters by one test (depression, anxiety and stress) ..plus saliva /serum cortisol will be great to confirm the level of stress in your subjects (mild,..).tq

"Why do a self report when a biological measure is available to you?" Because a biological measure in you may mean something totally different from the identical measure in me. Wwhich leaves us with a conundrum...what are we measuring, why are we measuring and what assumptions are we making about it? What do we think it tells us, and if we disagree, then what? Perhaps the biological measurement is just as susceptible to subjective bias as self report.........

You cannot measure stress...

Because it is not scientifically well defined. In stead you can measure global quality of life, happiness, wellbeing etc.

It's depend on your sample population, if you are interested to ask online I agree with Carla Benejam , but first you should define the sample population, for example when i study stress among employees in my country I decided to use DASS, because it's really easy to understanding, so we can got good and real result.

There is a difference between 'stress' and 'life events'. If you are interested in life events, meaning the actually stressful experiences that people have in the environment (e.g., got fired from a job, got divorced, etc.), then you should consider using a contextual life event and rating system, such as the Bedford College Life Events and Difficulties Schedule (G. Brown & T. Harris, 1978). Self-report questionnaires of life events suffer from very poor validity and reliability and, thus, I would not recommend any of them. Please see the writings of Scott Monroe on this topic before choosing a measure of life events (e.g., Monroe, 2006; Monroe & Harkness, 2005).

I am a little late in responding to this, but there is a clinical form out that has been validated and used for many years in measuring stress in military performance. It is called the Multiple Affect Adjective Checklist-R (MAACL-R). Lubin and Zuckerman 1999. It looks at anxiety, depression, hostility, dysphoria, positive affect and sensation seeking. It can be used as a trait measure as well as a state measure. You need to pay attention to how you word your question. If you are interested in how someone feels during a specific time you need to ask the question in those terms versus how they feel right now. Its a simple 132 adjective checklist. This form does not use the term stress. By using this term, it may create a bias in response. Good Luck!

I would use the Buros Mental Measurement Yearbook as resource to help deciding which test is appropriate for your professional needs.

I would use the Buros Mental Measurement Yearbook as resource to help deciding which test is appropriate for your professional needs.

@rakesh: maybe your comment underlines something very important - the interdependency between GAD (generalized Anxiety Disorder), clinical depression and Stress... Ohh, it would be so nice with a diagnostic tool differentiating between those three disorders, or maybe rather diagnosing the elements relative to each other....

To clarify: the area is mostly work-related stress. However, "work-related stress" rarely stands alone, but is connected to all other stressors in life. I agree there is a huge difference between measuring stressors (there are quite good inventories available) - and measuring the resulting consequences inside the individual - the percieved stress or "well-being". Ideally, I would love an instrument that could evaluate the outer relative to the inner - already correlated with biomarkers!

After being part of a research team in NY we developed medical tech for dealing with stress (1) related pathology. As a result we have researched and developed interventions for corporations and the public as per our published results. We can measure and reduce allostatic load (2)

GAD (3) is not always present in chronic stress but influences personality as per the type d psychometric instrument.

If you would like more info please email me at - [email protected]

Looking forward,

Justin

Dr Justin James Kennedy, Ph.D., D.Prof.

Regional Dean - Africa

UGSM-Monarch Business School Switzerland

[email protected]

[email protected]

+27.82.370.2080

UFS Business School finds a way to combat burnout | Leader.co.za

www.leader.co.za/article.aspx?s=6&f=1&a=3631

26 Apr 2012 – UFS Business School finds a way to combat burnout ... the business school has appointed Justin Kennedy to head up the Institute for Personal Excelence

Dr Justin Kennedy - 5th SA Innovation Summit

innovationsummit.co.za/speaker/dr-justin-kennedy

Dr Justin Kennedy. Justin J Kennedy150. Dr Justin Kennedy's Region: Free State; University

Justin J. Kennedy leads new Programme in Personal Excellence

www.ufs.ac.za/templates/archive.aspx?news=2368&cat=1

8 May 2012 – Justin J. Kennedy has been appointed as the Manager of the new Programme in Personal Excellence.

Twitter / UFS/UV: Justin J. Kennedy leads ne ...

twitter.com/UFSweb/status/200125705848242176

Justin J. Kennedy leads new Programme in Personal Excellence hosted by our Business School

The behavioural neuroscience of thriving ensures your knowledge ...

https://www.facebook.com/notes/ufs...-/390592047659835

UFS Business School wrote a note titled The behavioural neuroscience of thriving ensures your knowledge to sustain peak function - By Dr Justin Kennedy: UFS

(1) stress is defined as low HRV (heart rate variability) and high levels of cortisol.

(2) allostatic load chronic neurophysiological stress

(3) GAD Generalized Anxiety Disorder

It seems to be a questions with lots of possibilities :)

Thanks a lot everyone. I will spend a couple of days sifting through all the answers and read up on the different suggestions.

Do keep up giving ideas and references, though!

Hi Mette, thanks for the email. I hope this helps you doing your HW. With ref to CBT my work is actuallyt based in biofeedback which is worth discussing if you like:)

justin

All depends on what you need the scale for exactly but check out:

- Perceived Stress Scale (PSS), see http://www.ncsu.edu/assessment/resources/perceived_stress_scale.pdf

- Social Readjustment Rating Scale SRRS see http://www.simplypsychology.org/SRRS.html

- Student life experience ICSRLE google it

- Negative Life Events Inventory, attached.

- Daily Hassles from Anita DeLongis, Susan Folkman, and Richard S. Lazarus (1988)

Thanks again. I'll move forward with some of your suggestions. Looking forward to presenting the outcome at a future date (probably in early 2013 - I hope!). In the meantime I would like to direct your attention to two conferences - who knows that might give me the chance to meet some of you in person.

First conference is the 9th stress conference in Copenhagen, Danmark on 31 October 2012. (still open for contributions).

The other is the 34th STAR conference in Portugal, July 1 2013. (STAR stands for Stress and Anxiety Research Society).

http://www.star-society.org/ (It seems I can only add one link :(

Both places are peer-reviewed conferences with international speakers.

http://www.bispebjerghospital.dk/NR/rdonlyres/D53CCBAA-8DAB-4492-8764-DA72D0416448/0/Invitation_2012_engelsk.pdf

Hi Mette,

if you are looking for an interview-based measure of stress, you can take a look at the Life Events and Difficulties Schedule (LEDS) (Brown and Harris, 1978). I have not used it in my research as yet, but have recently read an article that did (Slavich, Monroe, Gotlib 2011) and found the measure quite interesting.

Hi Mette - I have a few comments for you ... Firstly, you might find it useful to get in touch with Professor Andy Smith (see link below which has his email address). He is based at Cardiff University (UK) and has years of experience in measuring stress (also my PhD professor). I do know that he has a student who has been evaluating a significant range of measures with the aim of developing an online diagnostic tool. You may find some common ground here to discuss.

http://psych.cf.ac.uk/contactsandpeople/academics/smith.html

Can I assume that you are familiar with the ERI and JDCS models and questionnaires for measuring stress? These have the most validation and I did find, with my PhD research that they accounted for most of the variance in my data. Additional variance was accounted for under the UK Management Standards framework but in reality, ERI and JDCS were the most useful.

I am not clear as to whether you are looking for a complete instrument or just single items such as the ones below which have been validated and I used regularly in my analyses for my PhD.

In general how do you find your job? (not at all/mildly/moderately/very/extremelystressful)

How do you find life in general? (not at all/mildly/moderately/very/extremely stressful)

Over the past 12 months how would you say your health has been? (very good/good/fair/bad/very bad)

I will attempt to attach a copy of the first questionnaire I used for my PhD - it contains an extensive number of scales. If you find any items you like I can send you the name of the scale - or indeed, some of the sections of my PhD. I did use the PSS in a second questionnaire but that didn't really add anything. I have become very interested in the concept of hardiness as a result of all this - apparently something that can be taught. Again, I can send information if you are interested. My email address is [email protected] if you wish to correspond separately (I do not log onto this everyday).

Best of luck and hope this is helpful.

PS not sure what I'm doing wrong but can't seem to attach file - email me if you'd like a copy of my questionnaire

HRV heart rate variability (via handy app)

Perceived Stress Scale (PSS) was developed by Cohen, Kamarck and Mermelstein (1983). Respondents evaluated the degree to which they had appraised situations in their lives as stressful, i.e., unpredictable, uncontrollable and overwhelming. The PSS is composed of 14 items on a five-point scale (from "never" to "often", e.g., "Have you ever been bothered by an unexpected event?"; "How often have you felt nervous or stressed?"). A study assessing parents' perceived stress reported Cronbach's alphas of 0.79 for the mothers and 0.77 for the fathers (Räikkönen, Pesonen, Heinonen, Komsi, Järvenpää, & Strandberg, 2006). in my study- Cronbach's alpha in our sample was 0.82.

Stress may currently evaluated by using the R-R signal , and its analysis by FFT and by the CZF method that we published on Chaos Solitons and Fractals. You find all the resources in www.saistmp.com We currently measure stress by an ad hoc software using such R-R signal and evaluating variability as well as PSD by FFT. The methodology is as it follows. At the first stage one measure R-R for five minutes and has to evaluate variability in HRV at rest for the subject. Soon after one has to stress the subject depending on the stress need . It may be physical or mental. In the first case the subject is submitted to physical exercise . In the second case he is submitted as example to a cognitive task.. We use Stroop effect. The new R-R is recorded . Consequently we use a suitable method and an home realized software . An index is finally calculated ranging from 0 to 1 and quantifying the level of stress of the examined subject. We are prompt for a collaboration. If you are interested , you may contact me at [email protected] or [email protected]. The suggested methodology pertains obviously to psychophysiological measurements. I hope this is satisfactory. Cordially. Elio Conte

"Stress" can mean stressor or stress response. As I understand it you are interested in the latter. As Rakesh Pandy says in his response, the definition of stress (including stress response) is important as the word is used very loosely. My answer would be simple: if you want to assess changes in chronic stress as a result of CBT, measure salivary cortisol before and after treatment. Cortisol levels can demonstrate ongoing emotional reactions (which would be of mental and physiological significance) in the absence of verbal report (and so likely in the absence of questionnaire detectablity). [Hofer, M.A., Wolff, C.T., Friedman, S.B., Mason, J.W., 1972. A psychoendocrine study of bereavement. Part I. 17-hydroxycorticosteroid excretion rates of parents following death of their children from leukemia. Psychosom. Med. 34, 481-491.] Critically, cortisol will always be cortisol even if your definition of "stress" changes so it gets round the validation problem.

Can you please post the conclusion after sifting through all the information please?

Thank you very much.

I think you should consider the paper of Kopp et al (2010) "Measures of stress in epidemiological research"

I see that the tendency in this debate is to ignore the importance of psychophysiological measurements ! We should be aware that the brain knows more than a subject may admit. In the definition as well in monitoring stress one cannot ignore the most important mirror that we have in the investigation. It is the HRV so connected to the ANS and thus to our involuntary behaviour. A subject may be scarcely aware of his/her psycholigical condition but as counterpart an R-R signal , well recorded, does not lie. Psychological disorders give a reduced heart rate variability and reduced heart rate variability may give sudden heart failure and often sudden death. I do not want to discourage the countinuous attempt to formulate a psychology as a totally independent discipline but a gap exists. We see continuous every day advances of knowledge by fMRI, electrophysiological studies and so on. These are pieces of knowledge well established. On the other hand we have continuous empirical psychological results . Such two fields remain distant just becuase a model is missing in the tentative to recoincile and to link such two apparently separated sectors of our knowledge. The way is the interdisciplinary approach. How may one establish stress without considering basic physilogical results as HRV , GSR , and still more.! I do not see another way!

Perhaps you can consider using cortisol as an indicator of stress. You can study the work of Hellhammer from Trier to get an impression of the pros and cons. When studying the measurement of stress responses with skin conductance we used the cortisol as a ground truth. The large response time lag did give us difficulties.

We have used cortisol as a pre and post measurement but the change is marginal. HRV (heart rate variability) showed marked improvements. Please reply to my email if you'd like to read the published research.

Looking forward,

Justin

Professor Justin J. Kennedy

Regional Dean - Africa

Professor of Organizational Behavior

Contact This Professor:

UGSM-Monarch Business School Switzerland

Flurstrasse 1, P.O. Box 30

CH-6332 Hagendorn-Zug,

Switzerland

+0041 41 780 08 82

[email protected]

South Africa

[email protected]

+0027.82.370.2080

http://www.ugsm-monarch.com/faculty/dr-justin-kennedy/

Hi . In our cardiac rehab program in Australia our Master of Psychology recommends the instrument called the DASS21 for measuring stress. He is writing a paper on this topic.

Thank you so much for all your answers. In the coming weeks I will examine all your input and probably also reach out to some of the contacts you so kindly have provided.

My conclusion for now is, however, that there is no such instrument as yet. An pen&pencil/PC-based inventory that has been correlated aganst biomarkers specificly in relation to stress.

An idea for further development is hereby offered! (and please do tell me if any of you decides to do so)

Lots of thanks,

Mette

I am not really sure how to answer you in that I don't have enough information. When you mention CBT I started to wonder what you are targeting. Most CBT work books have SUDS that are in response o the pacific thoughts nd events that cause a person distress. Reductions in these are the typical outcome measures; unless of course you are using CBT to treat an identified illness (such as PTSD) for which there are validated instruments ( I.e. the CAPSS) that get at frequency and intensity variables. So if you can be more precise it would be easier to think about what you are looking or hoping for.

I would concur with the Dass - perhaps the long version might work best. I use it clinically as we'll

I second Mr Elio in his opinion regarding the importance of biological factors in stress. To be comprehensive in your attempt to measure stress; biological , psychological and social factors should be considered. For biological factors , others have suggested cortisol ? blood ? saliva . You may also consider biofeedback . Whereas, psychosocial factors can be measured by questionnaire e.g DASS

I concur with Julio. Cohen's PSS is robust and simple to understand; there is even a 4-item version if you are concerned about response burden. Another thought is that you might want to consider the Impact of Events Scale-Revised (IES-R) by Horowitz which can be tailored to specific stressful life events if you have a targeted population of survivors.

@Julio: you are right... It is simply not feasible to use biomarkers with an online-tool :)

That's why I was hoping to find a measurement that had already been cross-validated with biomarkers (such as HRV or saliva, hair or....) I do realise that it does not save me from all sorts of other weaknesses and deliberations about what I am actually measuring - which is why psycometrics is so much fun!

I've enjoyed reading about all the different types of instrument for measuring stress and hopefully when I come across this kind of research in the near future I will think back to this discussion.

Hello Mette - I have a great deal of experience working with stress measurements. One of the most important tasks you face is to very precisely define stress (the cause as Sean puts it - but also the effect of a stressor) and its consequence (strain). It sounds like you are implicitly suggesting a short, tight path model (lots of ways to analyze this kind of data). So perhaps consider a priori definitions of stress and strain - there are several ways to measure them. Please post your definitions here and I will suggest some sound, validated instruments that you may find useful.

While I am posting -- a colleague did a similar experiment and made the argument that blood pressure variation from some baseline represented a stress response. His experiment required only a blood pressure cuff to measure strain. Stress itself was measured as the subject variation from baseline responses of a series of pictures viewed by controls. The various experiments are described, I believe, in the works published by John Hatch (not recent, I'm afraid), a psychiatrist.

I agree with Sean Collins - we do tend to use the word stress as a broad term, covering both strain and stressor. For entry level purposes in the system I am developing it suffices with experienced strain. When we go about trying to do something about the strain we certainly need to know something about the stressors. And when the workplace wants to do something preventive about the experienced stress they need to know about the common stressors as well.

Here and now I am mostly interested in the experience strain: is the person in question at risk or at no risk - healthwise? Or put in another way: would the person be likely or unlikely to benefit from an online blended learning portal about stress, (judged solely from the persons level of experienced strain and other factors)

Dear Prof Rakesh

As You may know stress can be evaluated in very different manners but I would suggest that You try the Nexus Technology that will give You in real time all of the physiologycal responses as well as face reading micro expressions and eye tracking - so adding this information with biochemichal tests You'll be able to train your patients beheavor to dimish this process - As You're in Dannemark I suggest to contact www.mindmedia.nl Look for his CEO Mr Erwin Hatzuiker - he for sure will have the best and most advanced solutions

Best Regards - Leopoldo Kneit

Hi Mette, I suggest looking at the CernySmith Assessment (CSA). The CSA evaluates and discovers areas of stress and roadblocks to adaptation for people working in cross-cultural situations. CernySmith Assessments (CSA) are online assessments that measure stress in 5 major areas: Organizational, Cross-Cultural, Relational, Personal, and Behavioral as it relates to the adjustment and well being of people living and working cross-culturally. See http://www.cernysmith.com/the-csa/

Dear Mette,

Are you looking for a tool taht will allow you collective or individual assessments?

Osipow OSI-R or Cooper OSi are not so bad for the collective aspect.

All the best

Dominique

@randal breslin: thanks for the suggestion, although I can see it is in English only and furthermore for expats. Also, I cannot find any validation studies on the site.

Yes, it is not a perfect fit. But I do know that the assessment is being put in other languages and does have a growing series of validation studies. If your are still interested, I recommend you contact Dr. Leonard J. Cerny directly as he is a great collaborator and you seem to have many overlapping interests. His email is:

[email protected]

There is an evaluation of work stress survey tools out there: maybe some of you might be interested: . It is from Monash University and you'll find quite detailed evaluations of tools, based on the validation studies made. Most of the instruments focuses on the stressors, rather than the strain experienced. The conclusion, however, is that no surveys have been validated enough just yet.

http://130.194.245.201/media/38388/Report_Workplace_Stress_Evaluation_Tools_1111.pdf

And there is another comparison report here, also focusing on the stressors, called "A critical review of psyco-social stressors", by the HSE in the UK

http://130.194.245.201/media/38388/Report_Workplace_Stress_Evaluation_Tools_1111.pdf

Gosh Mette what a lot of fine answers you've received to your question! As you likely know, there is a good deal of interest on the topic of measurement of stress in the United States. Many instruments for measuring the phenomenon have proposed; most in singular contexts and evaluating different aspects of the stress response. I suggest strongly that you send e-mail queries to the following people. They likely will have severals suggestions for you. They are all program officers for a current proposal request (RFA) available through the NIH.:

Nancy Shinowara, Ph.D.

Spinal Cord & Musculoskeletal Disorders & Assistive Devices Program

National Center for Medical Rehabilitation Research

National Institute of Child Health and Human Development

6100 Executive Boulevard, 2A03, MSC 7510

Bethesda, MD 20892-7510

Telephone: (301) 435-6838

FAX: (301) 402-0832

Email: [email protected]

Teresa L. Z. Jones, M.D.

Program Director for Diabetes Complications

Division of Diabetes, Endocrinology and Metabolism

National Institute of Diabetes and Digestive and Kidney Diseases

6707 Democracy Boulevard, Room 651, MSC 5460

Bethesda, MD 20892-5460

Telephone: (301) 435-2996

FAX: (301) 480-3503

Email: [email protected]

Robert Stretch, Ph.D.

Director, Division of Scientific Review

National Institute of Child Health and Human Development

6100 Executive Boulevard, Room 5B01, MSC 7510, MSC 7510

Bethesda, MD 20892-7510

Telephone: (301) 496-1485

FAX: (301) 402-4104

Email: [email protected]

You will find the specific RFA listed along with many other tools if you enter the following into your internet search bar (I use the Bing engine): NIH stress measurement tools.

Good luck!

I continue to insist on the importance of psychophysiological measurements. It is not to say that one must avoid subjective psychological evaluations based on empirical estimations as furnished by the subject. It is to acknowledge that we have also to day a lot of direct and rather valuable indications arising from physiological measurements directly linked to the subjective informations furnished from the ANS system. Again I think to the relevant HRV analysis , to GSR and still more. I look at this psychophysiological resources as presently valued instruments interfaced to more traditional approaches.

I agree with Kantermann as well, in that one must begin with a definition of both stress and stressors - is it psychological, physiological, psycho-social, behavioural? The research I am currently involved in looks at the psychobiology of stress ( we measure both the psycho-social aspects as well as the biological and physiological aspects). We assess our participants using questionnaires, ecological momentary assessment, momentary-mood and stress, additionally we take saliva samples from our participants to obtain cortisol samples, cortisol is a physiological measure of stress "the stress hormone" which peaks after a stressful event. The mechanism by which stress can affect the body is through the hypothalamic-pituitary axis making cortisol a plausible and known indicator.

Also, for questionnaire and surveys assessing stress - things that assess peak daily stress is handy and the POMS tool is also great (Profile of Mood States) assesses stress events.

Good points everyone!

Tiffany Rose Haig

What an amount of answers, points of view and readiness to help!! Thank you so much everyone!

As I see it there are several aspects which are relevant to measure, when treating "strain-related psychological reactions". We have the

1) stressors (what contributed to the reactions in the first place). These might be from 1.a the outside world (i.e. 1.a.1 work related or 1.a.2 private) or from 1.b the inner world (thoughts, aspirations, standards, norms etc.)

2) the physiological response to stressors (i.e. symptoms like headaches, tiredness, sweat, dizziness, chest pains - measured through medical examination and self report), cortisol levels and HRV

3) the psychological response (emotional or cognitive symptoms. The emotional measured by self-report - sometimes rated by peers or familiy and the cognitive also measured by self-report - rarely by cognitive testing)

3) might not match 2) or 1) as well as 2) might not correlate with 1) - although statistically the likelihood is higher for 2 and 3 to be high if 1 is high - maybe caused by the apparant "resilience factor" (which might in part be life style - exercise, sleep patterns, eating habits - or personality - emotional stability, locus of control? - or something else entirely).

What I am looking for is a validated instrument to measure the perceived strain - nomatter the percieved or real amount of stressors. It would be nice if the criterion validity had been thoroughly investigated, i.e. through physiological correlations. Becuase I would like to be reasonably sure that it was "stress" - and NOT borderline, depression or anxiety (opposing the obvious: it is all correlated :)

The definition I am following is the one from the EU OSHA:

"People experience stress when they perceive that there is an imbalance between the demands made of them and the resources they have available to cope with those demands. Although the experience of stress is psychological, stress also affects people’s physical health"

I have started to compare the different measurements mentioned here - lots and lots of inspiration! Thanks!

I think you've got it, Mette. Good going! If you want a synopsis of the evidence, see this text:

Title Who gets sick: thinking and health

Author Blair Justice

Publisher Peak Press, 1987

Original from the University of Michigan

Digitized Jul 30, 2008

ISBN 0960537619, 9780960537617

Length 407 pages

Best luck -

Alan

Be sure to check out this one by Koolhaas et al too: 'Stress revisited: a critical evaluation of the stress concept.'. Very useful I thought.

Stress, differently form anxiety or depression ,has specific correlates in HRV and Baroreflex sensiivity and also other physiological parameters. Alfa rhythm in EEG , as example , in anxiety tends to be low, in depressed subjects it tends to be high respect to normal standard expectations. Estimation of variability in R-R time series is important . It is a mirror of what is happening in ANS as well as in central nervous system. One must give an input , as example ... a stress by Stroop standard semantic conflicting images, recording R-R at rest and during the test. Variability of the R-R signal gives clear indication about the subjective condition of stress of the subject.

Stress, according to Selye, is the non-specific response (stress) of the body to whatever demand (stressor) is made upon it. However, the interpretation of the stressor (whether viewed, for example, as threatening or not), would make an enormous difference. Also, do not forget, there is negative (distress), as well as positive (eustress), all making demands upon the body in terms of adaptation. As mentioned by others, one of the most reliable indicators of stress is the measurement of cortisol in humans (corticosterone in animals) which depends on activation of the HPA axis. This can be carried out in the saliva.

In terms of validated psychosocial measures which could be utilized, depending on whether you are carrying out the measurement in children or adults, there would be various instruments which could be used. I could look up our proposals and get back to you. However, you can also look it up by looking at the work of Sonia Lupien, Suzanne King, Dominique Walker, Jens Pruessner, etc..

Hope this assists you.

Good luck!

MSP

Hi Mette,

I think that the most used scale is the Perceived Stress Scale (Cohen, 1994).

Aida

Does the answer of Aida Mendes give us complete assurance that always we find net correlation between perceived stress and psychophysiological ANS measurements as , in particular, HRV and BRS ( Baro-Reflex-Sensitivity) analysis?

Hello Elio,

Complete assurance is dificult to say :) but PSS is sensitive to measure the perceived stress and, as you know, there are other links between perceived stress and physiological response.

This is certainly true , Aida . However let me enlarge for an instant the question so to consider it as the general problem that we have to day under our eyes. No doubt that neurosciences in the last years have enabled us to have very important and fundamental new basic knowledges. Learning, memory, emotions , just to quote only some examples, have obtained for the first time an important identification as basic functions in our brain dynamics. This is due mainly to the fundamental contributions of biochemistry, genetics and important imaging techniques as fMRI, PET,TAC, Nuclear Medicne. On the other side we have the phenomenological and empirical results of psychology. My modest opinion is that this disicpline has arrived to explore a very large spectrum of investigation, has realized some important advances. However, In spite of such unquestionable new knowledges, obtained , I repeat, from one side and the other , finally an unsatisfactory reservation remains. Neuroscientists are convinced that adding step by step pieces of their knowledge , we will arrive finally to understand basic psycological functions , their advent and their dysfunctions in pathology. I have reservation on this profile. I see that , in spite of the great efforts performed from neurosciences from on side and psychology from the other side, a dark zone remains between these two different profiles of investigation .The two fields are really very distant. I continue to see a gap , and my opinion is that the reason is because a model is still missing having the ability to recover such dark zone. This is the reason because we have performed several studies starting with 1983 and , in particular, from 2003 , and we have arrived to identify a possible model that is based on quantum mechanics. Certainly, I am aware that psychologists tend to go on when some researcher attempts to suggest that physics is involved in this matter. But science is science. It is based on theoretical and experimental confirming results , and we have obtained detailed results in both such directions. I do not want to suggest you to look at our results and , in addition, I do not intend to retain arrogantly that finally we have discovered the way. I only indicate here that we have found about tle logical origins of quantum mechanics and this clearly indicates that it is involved in our cognitive functions, we have obtained experimental results confirming the role of quantum mechanics at perceptive and cognitive level. May be that we have identified a way based on quantum cognition. Care is extremely necessary in a so much fundamental field relating the basic foundations of our reality and of our subjective awareness, but the way of the "quantum cognition" at the present seems very promising in relation to the "model" that I previously outlined. What the link with the present our argument about the stress.?The arising lesson is that psychophysiology is promising in order to give detailed informations about the dark zone. Analysis of R-R intervals , of HRV , of BRS gives important informations about our ANS and such investigations relate directly our subjective psychological condition. A lot of experimental confirmations has been obtained. The HRV analysis is the first mirror that we have to " look in ". Again, I do not suggest to leave basic and experienced ways of more traditional psychological investigation. But HRV and BRS are the first mirror that we have to day and having also a scientific , net counterpart. I retain that we must take in great consideration such psychophysiological advance in the proper background of the investigation as well as in the proper sector of the diagnosis and of the therapy.

Hello Elio,

A very interesting explanation with which I agree in part. There is still a gap between psychological and physiologic research in stress area. But the psychoneuroimmunology has brourght interesting research results that enable new directions. In this field you can see the colaboration of some transactional orientation (cognitive aproach, for example) that brings new light to analyze this phenomenon.

Aida

For measuring chronic stress there is only one really viable option, the TICS scale (Trier Inventory of Chronic Stress). I know that the original was in German, and there is almost certainly a validated English translation available now, as they first published it in 2004. The Trier stress group are certainly one of the better groups for human psychology and stress (and the origin of the Trier Social Stress Test).

for references see:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3350460/

or the original German publication: Schulz P, Schlotz W, Becker P. Trierer Inventar zum chronischen Stress (TICS). [Trier inventory for chronic stress (TICS)] Göttingen, Germany: Hogrefe; 2004.

Hope this helps,

Jon

I do not see reasons to modify my position. We need subjective psychological data from one hand and psychophysiological measurements on the other hand.. They are currently expression of ANS that we no more must ignore. Correlations result evident of course. . In particular , we need HRV and BRS.. We currently follow this line of investigation in our laboratory with satisfactory results.

In answer to Elio, the original question was for an online CBT program. I agree with you that HRV and BRS are very much a gold standard in a research lab, but are not applicable to an online solution, that I have the impression is not necessarily research orientated.

Could the original poster (Mette) please give us a bit more information about what she is trying to do, and how she want to use her online instrument for measuring stress and for CBT?

Thanks

Jon

Jonathan, I hope that I am not in error........but I do not see difficulties performing an on line HRV analysis. An appropriate software is required and a correct methodology but sorry if I am misunderstanding.. Still. We use HRV and BRS not only for research purposes but also for diagnosis and therapy.

I too am interested in the interface between the psychosocial measures and the biological. However in a study on the link between depression and heart disease we found the Australian questionnaire measure, the DASS, Depression, Anxiety and Stress scale, a good responsive stress measure as some of its questions ask about the body experiences of stress and it correlated well with our semi-structured interview and blood/biomarkers. By Lovibond and Lovibond, it is free to user and has good psychometric properties. This has meant a high uptake for those tracking depression, anxiety and stress in larger population studies. It is in English, but plain English, and would be worth a look. I have attached the questionnaire and the scoring template in the next answer as I don't seem to be able to do two files in the one response.

Good luck!

Here is the scoring template for the DASS and the ref: Lovibond, S.H.& Lovibond, P.F. (1995) Manual for the Depression Anxiety Stress Scales. Sydney: The Psychology Foundation of Australia Inc.

There is TQH- Trauma History Questionary http://www.ptsd.va.gov/professional/pages/assessments/thq.asp

This is a recent work which might help

You may use the Perceived Stress Scale : http://www.mindgarden.com/products/pss.htm (free of charge). It works very well.

The problem was also to see if we may measure it by psychophysiological tests since we often may not be aware of it or at least we are unable to give a direct and objective rather than subjective indication.

Shona, I am not sure that I am understanding your answer correctly. However, I may guarantee that HRV analysis , done in a proper manner and following a detailed methodology , gives great results. It is certainly strange my language. I should enter in more details but unfortunately this is impossible for me at the moment since my pending patent of the methodology and of the relative device. It is for this reason that in my past answers I invited scholars having the problem to give estimation of stress by psychophysiological measurements , to contact me directly.

Consider my Daily Stress Inventory. Correlates well with cortisol and VMA

Consider my Daily Stress Inventory. Correlates well with cortisol and VMA

The perceived stress scale is quite good and is used in a lot of published research. Similar to the discussion above though, you should probably use a measure that is parallel to any stress theory which underpins your intervention research.

Please, define target population. There are many psychometric instruments but every and each one of them has a specific target population. Moreover, there are different types of stress. It would be insufficient to evaluate stress levels, without defining which life sector is mostly affected. I wish all the best!