Tool to measure stress

For each endorsed stressor, they are asked follow-up questions to provide greater context about the experience e. Both measures provide a comprehensive assessment of stressor exposures across the lifespan, and use different methods to determine the severity of these experiences. For example, caregiving for a family member with a debilitating illness is often considered a chronic stressor because of the constant physical and emotional demands.

There is a significant amount of research examining the impact of being a dementia caregiver, in particular, given the large increase in the number of family dementia caregivers as the population ages in the United States. Thus, a better predictor of health decline would be the degree to which caregivers report high levels of psychological burden from their caregiving role.

Stress responses can be measured with self-report measures, behavioral coding, or via physiological measurements. These responses include emotions, cognitions, behaviors, and physiological responses instigated by the stressful stimuli. Responses to acute stressors have traditionally been studied in controlled laboratory settings in order to capture responses that unfold within minutes of stressor exposure e.

A commonly used acute stress paradigm is the Trier Social Stress Test TSST , a standardized laboratory stress task in which participants give a speech and perform mental arithmetic in front of judges Kirschbaum et al. The TSST reliably evokes an acute stress response for the majority of participants. Outside of the laboratory, new technology has enhanced our ability to capture real-time stress responses in daily life using mobile phones and wearables, which many researchers are now doing.

Considering the impact of both stressor exposure and stress responses on health may improve the prediction of health outcomes, as many models of stress propose that the stress response mediates the effect of stress exposures on health outcomes McEwen, ; Wheaton et al. Due to constraints on participant burden and other considerations, difficult choices about which type of stress to measure need to be made by researchers. Common types of psychological stress measured using self-report questionnaires in adult samples are major life events, traumatic events, early life stress exposure, and current chronic or perceived stress in various domains i.

The choice of which type of stressor exposure to measure depends on what is most relevant to the study population, the specific research question, and the hypothesized mechanisms linking that stress type to the outcome of interest. For example, measures that capture religious persecution or combat exposure would be particularly important for a sample living in a conflict zone, while the amount of overwhelm related to being a parent parenting stress may be most relevant for a sample of mothers caring for their child who has an autism spectrum disorder.

In both cases, it would also be important to measure types of stressors that may not be directly related to the circumstances—such as levels of loneliness and financial strain. In addition to identifying stressor type s of interest, there are several key measurement considerations when choosing specific measures of stress to include in studies or analyzing existing stress measure data.

These considerations include characteristics of the stressor or response e. We briefly describe these aspects below see Epel et al. Table 1 provides definitions for each of these timescales.

It is important to note that naturalistic experiences of stress rarely fall neatly into one category. For example, death of a loved one is often considered a major life event but, depending on the cause of death, may also be considered a chronic stressor, such as if the family member was sick for years or months before the death.

Similarly, arguments with a spouse may be considered an acute stressor, but if they happen every day they may be considered chronic. There is a significant amount of gray area between categories. Researchers should first make a thoughtful attempt to pick the category that best aligns with the stressor and with the way that stressor type has been described in past research, and then describe the exposure with as much specificity as possible.

Responses to stressor exposures provide additional useful information beyond measuring stressor exposure alone. Stress responses include psychological, behavioral, cognitive, and physiological reactions related to the stressor exposure that can occur before, during, or after the exposure.

Psychological stress responses include specific emotions triggered by the stressor, as well as efforts to regulate that emotion Gross, Behavioral responses include coping behaviors such as smoking or seeking social support. Cognitive responses include appraisals of the exposure e. Physiological responses include immune, autonomic, neuroendocrine, and neural changes related to stressor exposure. Further details about the various stress responses deserve more attention than can be described here Epel et al.

As a part of selecting stress measures, researchers should identify the type of stress response that is most relevant for their research question and sample. Often, studies will assess multiple types of stress responses simultaneously. There are additional stressor exposure attributes that can be described and captured to thoroughly assess the exposure.

These include, but are not limited to, duration, severity, controllability, life domain, the target of the stressor e. Lack of control, social status threat, and stressor severity have been identified as potent attributes that predict worse outcomes across a range of stressor types and scenarios.

In addition to the timescale of the stressor, another important characteristic of stressor exposure is the developmental or life stage during which the stressor occurs. This is because developing systems are more open to environmental cues and are thus more likely to be impacted by stress exposure. Sensitive periods during which stress may have the greatest effect are likely: prenatal Van Den Bergh et al. Identifying and measuring stress during sensitive periods could greatly increase our understanding of who is at risk for the negative effects of stress, the mechanistic pathways linking stress exposure to health decline, and where and how to focus intervention efforts.

The window of measurement is also essential to consider to avoid measurement error and improve specificity in hypotheses. Measures can ask about stressors and stress responses across a wide range of time frames, such as in the present moment, over the course of that day, the past week, the past month, the past year, in childhood, or across the entire lifespan.

For example, there are fundamental differences in a measure that ask participants to report on stress exposure in the past month versus across their lifespan. The latency between stressor exposure and measurement is crucial, as retrospective autobiographical reports are prone to bias and error, especially when there have been years or decades since the exposure in question Bradburn et al.

In addition to the latency between exposure and measurement, several other factors can impact the accuracy of retrospective reports, such as mental state at the time of recall and the emotional salience of a given memory Shiffman et al. This may lead to overestimating the frequency of emotionally salient stressors and underestimating the frequency of more mundane, daily stressors Bradburn et al.

For these reasons, it can be beneficial to measure stressor exposure and responses in close proximity to their occurrence whenever possible. The experimental studies examining acute stressor exposure and responses, there are additional considerations with the measurement assessment window.

Because the timing of stressor exposure is controlled, researchers can begin measuring psychological, behavioral, and physiological states prior to the stressor exposure and continue measuring throughout and after exposure. By measuring responses before, during, and after exposure, researchers can access and predict anticipation of and recovery from the stressor exposure.

There are of course numerous considerations for selecting the appropriate stress measure for your study. In sum, researchers should identify the type or types of stress that are most relevant to their research question and sample.

Selection of stress measures should also account for measurement characteristics, such as the life stage during stressor exposure and the measurement assessment window e. Beyond these stress-specific considerations, researchers should also follow general best practices for measure selection. For example, validated scales should be used when available. Measures should also be selected based on the uniqueness of the sample, and hile validated scales are preferred, some samples or exposures may require researchers to develop a new scale or modify an existing scale to fit their needs.

These practical steps for selecting a stress measure are summarized in Table 2. A comprehensive review of these literatures is outside the scope of the present article; however, the following section highlights foundational studies linking these stress types physical health, with a particular emphasis on cardiovascular disease because it is the leading cause of death in developed countries and mortality. Effect sizes are included where possible, as are references to reviews and meta-analyses for further reading.

Despite initial compelling work on the impact of cumulative life stress on cardiovascular disease outcomes, this area of research is still in its infancy, with a need for measurement approaches to be unified across research studies to allow for building of a collective science Albert et al.

Decades of research have shown that heightened cardiovascular reactivity and delayed recovery to acute stressors are prospectively associated with increased cardiovascular disease risk Brosschot et al. Cortisol and inflammatory responses to acute stressors have also been shown to prospectively predict incident hypertension Hamer and Steptoe, ; Steptoe et al. Heightened reactions and prolonged recovery time periods may be driven by perseverative cognitions before worrying and after rumination stressor exposure Brosschot et al.

Despite the evidence linking reactivity to disease outcomes, the clinical meaningfulness of these associations is still debated Treiber et al. In addition, there are several other reactivity patterns that have been hypothesized to represent maladaptive response profiles such as lack of habituation when exposed to repeated stressors of the same kind see McEwen, Thus, the clinical meaningfulness of different stress reactivity profiles is largely debated.

The evidence linking early life stress to increased adult disease risk and mortality is strong. A foundational study in this area, the Adverse Childhood Experiences ACE Study, included nearly 10, adults and demonstrated that a greater number of self-reported retrospective adverse childhood experiences e. Convincingly, reporting seven or more ACE was associated with three times the likelihood of heart disease compared to reporting no ACE Dong et al.

These findings have been so compelling that significant changes in clinical and educational settings have been undertaken in recent years to recognize the role that early trauma has on current and future cognitive, socio-emotional, and behavioral outcomes for both children and adults. Epidemiological studies consistently demonstrate associations between high work stress and worse physical and mental health. One of the most widely studied models of work stress is job strain, which is a combination of high demands workload and intensity and low control Karasek, Decades of research has linked high job strain to anxiety and depression, increased blood pressure BP , cardiovascular events, and metabolic syndrome Chandola et al.

Other components of work stress, such as effort-reward imbalance, also predict cardiovascular disease risk Dragano et al. These strong relationships suggest that meaningful connection with others is an essential component of health and well-being. Several short measures have been created to capture this important social determinant of health, including a validated three-item measure of loneliness Hughes et al.

There are numerous plausible biological pathways linking stress to cardiovascular disease, with most of the current evidence pointing to stress-related alterations in the immune, autonomic, and neuroendocrine systems. The brain networks that orchestrate stress-induced changes in these peripheral systems have also been identified Gianaros and Wager, ; Gianaros and Jennings, , and can be described as the systems related to threat processing, safety processing, and social cognition Muscatell and Eisenberger, In this model, stressful events cause stress responses that involve activation of physiologic systems.

In the short term, mobilizing physiological resources to respond to a discrete event or threat is adaptive. In the long term, however, frequent and repeated mobilization of these resources wears down these response systems and maladaptive patterns appear McEwen, This is because we do not currently have data that demonstrates the slow degradation of multiple physiological systems over decades in humans, an effort that requires tremendous investment.

Other potential pathways include stress-related changes in endothelial function, elevated chronic inflammation, metabolic dysfunction, changes in DNA repair, changes in gene expression, and telomere shortening.

These pathways are relevant for numerous chronic diseases beyond cardiovascular disease. Associations between stress and immune system functioning are especially relevant given that the major diseases of aging in the United States are mediated, in part, through the immune system.

The top three leading causes of death in the United States—cardiovascular disease, cancer, and chronic lower respiratory disease—all share the common thread of being characterized by elevated chronic inflammation Aghasafari et al. Because of this common thread, chronic systemic inflammation has become a recent focus of health research.

Stress exposure has been examined extensively as a predictor of increased systemic inflammation. Indeed, elevated systemic inflammation has been found in those experiencing chronic stress like caregivers Gouin et al. A short-term inflammatory response to stress is thought to be adaptive because it involves recruiting immune cells to the site of a real or potential injury in order to heal wounds resulting from stressor exposure. However, when there is no wound to heal, as is the case with psychosocial stressor exposure, repeated or exaggerated inflammatory responses may cause long-term damage and contribute to disease processes Black and Garbutt, ; Miller et al.

This is likely because acute stress is not the only state that evokes reliable biological changes e. Other non-acute stress states, such as feeling excited, focusing attention on non-negative affect inducing stimuli, or exercising, also trigger biological responses that are similar to those evoked by negative affect inducing acute stressors like increased heart rate and blood pressure.

While measuring stress-related biomarkers may not provide a perfect indicator of whether someone is under stress or not, there are still compelling reasons to include these biomarkers in research studies of stress and health.

Stress-related biomarkers are objectively measured biological indicators of physiological processes that are either implicated in the pathway from stress to disease or serve as a marker of that process. In typical models of the stress-health relationship, the stressful event X leads to a biological change Y that then leads to the disease state or related outcome Z. Stress-related biomarkers can be the variable inserted in any component X, Y, or Z of this model; examples of the stress-related biomarker in each part of this basic model are shown in Figure 1.

In example A, the biomarker serves as a mediator, or a part of the causal pathway between a stressor and a health outcome. In example B, the biomarker serves as a predictor of stress-related psychosocial and behavioral processes that ultimately impact health outcomes. In example C, the biomarker serves as an outcome of psychological and physiological responses to a traumatic stressor.

The way a biomarker is conceptualized e. As such, choosing a stress-related biomarker to include in a study depends on the design of the study and the outcomes of interest. Table 3 provides further tools for how to choose the appropriate biomarker. Examples of how stress-related biomarkers can be modeled as either the predictor, the mediator, or the outcome in research studies.

Essential questions for following best practices in choosing an appropriate stress-related biomarker. One area of research that requires particularly careful consideration of biomarker selection is when biomarkers are used as an outcome in psychosocial intervention trials. The scientific community is often eager to find an objective biological indicator that a psychosocial intervention can improve health; this is typically done by measuring improvement in a biomarker from pre- to post-intervention.

This approach is problematic for several reasons, including variability in baseline biomarker profiles, unknown reliability of biomarker assessment over time, unknown stability of these changes, and lack of evidence for the long-term impact of small changes in stress-related biomarkers on disease risk. Therefore, biomarkers should not replace self-report, behavioral, and cognitive outcomes as primary outcomes in psychosocial intervention trials aimed at reducing stress or related goals.

Despite stress exposure being an inevitable part of life, not everyone develops stress-related illnesses at the same speed. One primary reason for this is that stress exposures are not distributed evenly across social groups. Women, young adults, members of racial-ethnic minority groups, divorced and widowed persons, and poor and working-class individuals report greater chronic stress and cumulative stress exposure across their lives Thoits, In addition, recent research has demonstrated that both psychological and physiological stress responses vary remarkably within and between people.

Individual-level differences and environmental contexts interact to influence the psychological and physiological stress response trajectories. These include socioeconomic and cultural factors, genetic and developmental factors, historical and current stressors, stable protective factors, and health behaviors.

A model integrating these different levels of experience is presented by our group in detail in Epel et al. Transdisciplinary model of psychological stress: Integrating contextual, historical, habitual, and acute stress processes. Figure 2 presents a transdisciplinary model that describes psychological stress as encompassing as a set of interrelated processes. These contextual factors include individual-level characteristics such as personality and demographics, the environment in which one lives, current and past stressor exposures, and protective factors—all of which combine to determine the baseline allostatic state of physiological regulation, and the lens through which stressors are perceived and assigned meaning.

Contextual factors and habitual processes together influence psychological and physiological responses to acute and daily stressors. These responses, if dysregulated, are thought to lead to allostatic load and ultimately biological aging and early disease. Reprinted from Frontiers in Neuroendocrinology Epel et al.

Advanced statistical models can be used to examine variability in stress responses both psychological and physiological within and between people Bryk and Raudenbush, ; McArdle and Epstein, Between-person variability means that different people respond to the same stressor in a variety of ways. Cortisol can be used as an example of variability in physiological stress responses Cortisol generally increases in response to laboratory-based acute stress tasks if they are uncontrollable and characterized by social-evaluative threat Dickerson and Kemeny, , such as the TSST described earlier Kirschbaum et al.

However, around 30 percent of people do not mount a cortisol response, and there is tremendous variability in the size of the response. Individual-level predictors of this variability include age, gender, sex steroid levels, smoking, coffee, and alcohol consumption Kudielka et al.

Interestingly, these differences are not driven by differences in the emotional responses to the task as acute stressors are not strongly correlated to the physiological responses. In a review of 49 acute stress studies, only 25 percent reported a significant correlation between the two emotional and physiological responses Campbell and Ehlert, Empirical evidence supports a strong relationship between psychological stress and disease development.

These studies may be underestimating the impact of stressor exposure and the stress response on health, given that measuring these constructs has been challenging and limited. Recent work in the stress field has identified important aspects of psychological stress to capture in order to fully test the role that psychological stress plays in predicting disease; these include capturing the specific type s of stressor exposure, a wide range of psychological, cognitive, behavioral, and physiological responses to the exposure, and contextual and individual-level factors that moderate the impact of the exposure and response.

In this article, we identified ways for researchers to improve the language specificity when describing stress measures and offered guidance on how to choose the appropriate stress measure. We encourage the adoption of more precise language when writing about stress in academic papers, more careful selection of stress measures, with a focus on validated measures when possible, and theoretically driven integration of mechanistic pathways linking stress to health outcomes.

The ultimate goal of having sophisticated research on the relationship between stress, health, and well-being is to develop evidence-based ways to help people thrive in our stress-filled world.

Members of the Stress Measurement Network provided essential input on the thoughts presented here, and we thank them for their contribution. National Center for Biotechnology Information , U.

Journal List Health Psychol Open v. Health Psychol Open. Published online Jul 8. Author information Copyright and License information Disclaimer. Email: ude. This article has been cited by other articles in PMC. Abstract Despite the strong evidence linking psychological stress to disease risk, health researchers often fail to include psychological stress in models of health.

Keywords: health psychology, measurement, psychological distress, quantitative methods, stress. Introduction Epidemiological studies confirm that both experiencing a greater number of stressful events and reporting high perceived stress over long periods of time are associated with worse mental and physical health, and mortality Epel et al. Measuring stressor exposures versus stress responses Stressor exposures can be measured with self-report questionnaires such as a life events checklist, assessed by an interviewer, or objectively determined based on proximity to an event e.

Selecting stress measures Due to constraints on participant burden and other considerations, difficult choices about which type of stress to measure need to be made by researchers. Stressor and stress response characteristics In addition to identifying stressor type s of interest, there are several key measurement considerations when choosing specific measures of stress to include in studies or analyzing existing stress measure data. Table 1. Types of stress by timescale.

Type of stress Definition Relevance for health Chronic stress Chronic stressors are prolonged threatening or challenging circumstances that disrupt daily life and continue for an extended period of time minimum of one month. People under the chronic stress are at greater risk of chronic illness, mortality, and accelerated biological aging Epel et al. Provides all means for continous stress monitoring and alerts on instant stress changes and an ability to treat the stress before it can harm the organism and thereby reduces the negative impact on your body.

Easy-to-use personal stress management tool for home and office use. Highest ratings from professionals around the world. Designed for people with high blood pressure, sleep disorders, health cautious individuals. About Health System. Health News. Search this site:. Related categories. Relaxation Stress monitor Stress management tips Stress management tools Stress management.

Related links. Monitoring stress at home. Monitoring stress for stress-less life. Stress level and blood pressure. Stress level and health risks. Stress monitor and heart attack. Stress Monitor and stress prevention.

Stress Monitor - using at work. Using Stress Test. Ways to measure stress [View]. Stress monitor: To use this stress monitor, you will have to plug the device in the USB port of the computer. Biodots: These are plastic circles or squares which need to be attached to the skin preferably on the skin between the index finger and the thumb. Stress Monitor: Stress Monitor provides all means for continous stress monitoring and alerts on instant stress changes.

Login to post comments. Using a Stress Relieve Program. Browse by category. Stress Monitor. Stress Sweeper. Designed for Health - Health Reviser.