Approaches to stress assessment

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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.

Environmental Category Stressor
Physical environment Hazards (European agency, 2000)

Persistent noise (Holt, 1982 as cited in European agency, 2000)

Time and body-rhythms

  • Broken sleep
  • Shift work
  • Air travel
  • Pain

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

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)
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.

A percieved threat will lead a person to feel stressed. This can include physical threats, social threats, financial threat, and so on. In particular it will be worse when the person feels they have no response that can reduce the threat, as this affects te need for a sence of control. Generally speaking, any threat to needs is likely to lead to stress being experienced.

Financial pressures (Holmes & Rahe, 1967 as cited in Hart, 2007)

Interpersonal conflict (European agency, 2000; Mahoney, 2001)

Psychological symptoms

(Simes, 2006)

Irritability, hostility


Depression, withdrawal

Emotional instability

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

Compulsive behvaiour


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


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

MacArthur, J., MacArthur, C. (2000). Measures of psychological stress. Retrieved August 25, 2008 from

Mason, J. (2001). Guide to stress reduction. California, USA: Celestial Arts.

Simes, W. (2006). Various articles retrieved from 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