Approaches to stress assessment
Debbie St John, Tessa Grinlinton, Erna van der Merwe, Victoria Walden, Sally Marett, Simon Marks, 2008
Approaches to stress assessment
Our stress response arises from complex interaction between our environment and our psychological state. Stress affects us in many ways cognitively, emotionally, and physically.
Assessment of stress is therefore not a straightforward matter, and a number of varying approaches have been developed. These approaches may be grouped into three categories – environmental, psychological, and biological (MacArthur & MacArthur, 2000).
A comprehensive stress assessment should incorporate some elements of each of these approaches, although it should usually be biased towards the assessor's area of expertise. It makes sense for a psychologist for example to focus on psycho-social and behavioural measures whereas a massage therapist will tend to focus on physical symptoms such as muscular aches and pain, breathing pattern and headaches.
Environmental approaches to stress assessment use events or experiences which occur in the client's life as the basis of their assessment
Environmental stressors can be related to the physical environment, the interpersonal environment, or the dietary habits of the individual. In addition because the work-environment is often a major contributor to stress, it is considered as a separate category here.
|Physical environment|| Hazards (European agency, 2000)
Persistent noise (Holt, 1982 as cited in European agency, 2000)
Time and body-rhythms
|Interpersonal environment|| Lack of social support (European agency, 2000)
Interpersonal conflict (European agency, 2000)
Conflicting demands of home and work (European agency, 2000)
|Dietary habits|| Sympathomimetic agents - coffee, tobacco, refined sugar (Mason, 2001)
Irregular or imbalanced meals (Chek, 2004).
Dehydration (Zhu, Wang, Tan, Duan, Kuang, Xu, Ju, 2006)
Sodium (from table salt) increases fluid retention resulting in increased nervous tension & blood pressure
|Work environment|| Unreasonable workload (European agency, 2000)
Deadlines (European agency, 2000)
Lack of control over work (European agency, 2000)
Examples of environmental assessment
Psychological approaches to stress assessment consider the client's response to the events or experiences in their life, and indicators of psychological ill-health. Common examples of psychological approaches to stress assessment include
- Daily event measures – where the client records stressful experiences in a journal
- Perceived stress measures – where the client completes a survey in which they identify to what degree they experience common psychological indicators of stress
- Negative affect measures – similar to perceived stress measures, but focussing instead on negative emotional responses.
Further reading on this topic
|Common psychological assessment indicators|
|Psychological stressors|| Perceived lack of control. When we are uncertain about situations we are unable to predict, and hence feel we are not in control, and hence may feel fear or feel threatened by that which is causing the uncertainty.
| Psychological symptoms
| Irritability, hostility
Negative interpretation of events and negative self-talk
Lack of concentration
Feeling of a lack of control or need for too much control
Increased consumption of alcohol, cigarettes, or drugs
Biological approaches to stress assessment focus on monitoring of physiological indicators which are known to be associated with stress.
Common examples of this approach in the research literature involve taking samples of salivary cortisol, or assessment of brain activity using an EEG machine. This type of biological assessment is not practically useful in a small practice. However other methods of biological assessment, while perhaps more subjective also have merit.
In a massage practice, the types of biological indicators that we might be interested in include
- Frequency of headaches
- Muscle tension
- Aches and pains
- Trigger points
- Breathing pattern
Other physiological symptoms of stress which may be incorporated into a stress assessment include (Simes, 2006)
- Cardiovascular symptoms such as increased heart rate, elevated blood pressure and chest pains
- Digestive complaints such as nausea, vomiting, diarrhea and constipation
- Increased frequency of illness
Chek, P. (2004). How to Eat, Move and Be Healthy. San Diego, CA: C.H.E.K Insitute
European agency for safety and health at work (2000). Research on work-related stress. Luxembourg: Office for Official Publications of the European Communities. Retrieved July 22, 2008 from http://osha.europa.eu/en/publications/reports/203
MacArthur, J., MacArthur, C. (2000). Measures of psychological stress. Retrieved August 25, 2008 from http://www.macses.ucsf.edu/Research/Psychosocial/notebook/stress.html
Mason, J. (2001). Guide to stress reduction. California, USA: Celestial Arts.
Simes, W. (2006). Various articles retrieved from http://cehs.unl.edu/stress/resources.html on December 3, 2006.
Zhu, Z., Wang, B., Tan, Q., Duan, X., Kuang, F., Xu, Z., Ju, G. (2006). Effect of water restrictions on the physiological parameters, psychological behavior and brain c-Fos expression in rat. Neuroscience bulletin 22(3), 144-150. Retrieved July 30, 2008 from http://www.neurosci.cn/chinese/article/v22/144-150%2005027.pdf