Approaches to stress assessment

Contributors
David McQuillan (2008). Otago Polytechnic: Massage therapy course

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
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.

Examples of environmental assessment


 * Life events questionairre

Psychological approaches
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
 * Measures of psychological stress (MacArthur & MacArthur, 2000)

Biological approaches
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
 * Insomnia

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
 * Fatigue
 * Increased frequency of illness