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ASSESSMENT OF PSYCHOLOGICAL STRESS. Pittsburgh Mind-Body Center Summer Institute June 4, 2008 Tom Kamarck, Ph.D. Barbara Anderson, Ph.D. Low Socioeconomic Status Natural Disasters Bereavement Unemployment. DEFINITION. SOCIAL ENVIRONMENT.

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Assessment of psychological stress
ASSESSMENT OF PSYCHOLOGICAL STRESS

Pittsburgh Mind-Body Center Summer Institute

June 4, 2008

Tom Kamarck, Ph.D.

Barbara Anderson, Ph.D.


Low Socioeconomic Status

Natural Disasters

Bereavement

Unemployment

DEFINITION

SOCIAL

ENVIRONMENT

PSYCHOLOGICAL

STRESS

VULNERABILITY

TO DISEASE

MEASUREMENT

Marital Strain

Job stress

Caregiving

Discrimination


  • GOALS

  • Major approaches to conceptualization and measurement of stress– pro’s and cons.

  • 2. Initiatives by PMBC faculty to improve our ability to quantify chronic stress exposure.


ENVIRONMENT

ORGANISM


ENVIRONMENT

ORGANISM


ENVIRONMENT

ORGANISM


Definitions of stress
DEFINITIONS OF STRESS

  • Response-based model

  • (Selye, 1974) “Stress is the nonspecific response of the body to any demand made upon it.”

  • Stimulus-based model

  • (Holmes & Rahe, 1967) Stress involves “…events whose advent…requires a significant change in the ongoing life pattern of the individual.”

  • Transactional model

  • (Holroyd & Lazarus, 1982) Stress involves the “judgment that environmental or internal demands tax or exceed the individual’s resources for managing them.”


The temporal dimension

ENVIRONMENT

ENVIRONMENT

ENVIRONMENT

ORGANISM

ORGANISM

ORGANISM

THE TEMPORAL DIMENSION


The temporal dimension1
THE TEMPORAL DIMENSION

ACUTE

CHRONIC

RESPONSE-BASED

STIMULUS-BASED

TRANSACTION


DEFINITIONS OF STRESS

  • Response-based model

  • (Selye, 1974) “Stress is the nonspecific response of the body to any demand made upon it.”

  • Stimulus-based model

  • (Holmes & Rahe, 1967) Stress involves “…events whose advent…requires a significant change in the ongoing life pattern of the individual.”

  • Transactional model

  • (Holroyd & Lazarus, 1982) Stress involves the “judgment that environmental or internal demands tax or exceed the individual’s resources for managing them.”


Definitions of stress1
DEFINITIONS OF STRESS

  • Response-based model

  • (Selye, 1974) “Stress is the nonspecific response of the body to any demand made upon it.”

    NEUROBIOLOGICAL RESPONSES:

    STRENGTHS:

    Objective assessments

    WEAKNESSES:

    Many-to-one relationship between response determinants and neurobiological responses.


Definitions of stress2
DEFINITIONS OF STRESS

  • Response-based model

  • (Selye, 1974) “Stress is the nonspecific response of the body to any demand made upon it.”

    SELF-REPORT RESPONSES:

    STRENGTHS:

    Salient, face valid.

    WEAKNESSES:

    Psychological symptoms are frequently characterized as outcome measures in the relationship between stress and adaptation rather than as predictors.


Definitions of stress3
DEFINITIONS OF STRESS

  • Response-based model

  • (Selye, 1974) “Stress is the nonspecific response of the body to any demand made upon it.”

  • Stimulus-based model

  • (Holmes & Rahe, 1967) Stress involves “…events whose advent…requires a significant change in the ongoing life pattern of the individual.”

  • Transactional model

  • (Holroyd & Lazarus, 1982) Stress involves the “judgment that environmental or internal demands tax or exceed the individual’s resources for managing them.”


Stimulus-based model

  • What is “stressful” about the demands of the environment? Relevant psychological processes.

  • What are the major temporal domains that are important to assess? (daily hassles, life events, chronic difficulties)

  • How do the demands of the environment summate?

  • What are the relevant life domains that should be the focus of our attention (occupation, marriage, caregiving responsibilities)?


Stimulus-based model

  • Life events approach

    • Adolf Meyer’s “life chart” (1866-1950)

    • Harold Wolff NY Hospital-Cornell

    • Thomas Holmes 1955

      Schedule of Recent Experiences

    • Richard Rahe

      Social Readjustment Rating Scale


Stimulus-based model

  • Life events approach

    Assumptions of the original method:

  • What makes stress stressful? Adaptation.

  • Impact of events is linear, additive and cumulative.

  • Equal effects across individuals.


Schedule of Recent Experience (1967)EXAMPLE ITEMS

  • Mark under the appropriate time periods when there has been either a lot more or a lot less trouble with the boss.

  • Mark under the appropriate time periods when there was a major change in number of family-get-togethers (e.g., a lot more or a lot less than usual).

  • Mark the number of times in each appropriate time period that you had an outstanding personal achievement.

  • Mark the number of times in each appropriate time period that there was a major change in working hours or conditions.

    32. Mark the number of times in each appropriate time period that there was a major change in living conditions (building a new home, remodeling, deterioration of home or neighborhood).


Stimulus-based model

  • Life events approach

    STRENGTHS: In theory, these measures allow us to identify the environmental sources of stress in a manner that is unconfounded by the individual’s reaction or coping style.

    WEAKNESSES:

    1.Problems with subjectivity (threshold for item endorsement)

    2. Problems with reliability (retest not bad, but only 60 % of items endorsed at one time are also endorsed at another).

    3. Problems with memory accessibility (fall off about 5 % per month).

    4. Problems with content validity.

    5. Uneven representation of chronic difficulties.


Stimulus-based model

  • Life events approach

    STRENGTHS: In theory, these measures allow us to identify the environmental sources of stress in a manner that is unconfounded by the individual’s reaction or coping style.

    WEAKNESSES:

    1. Problems with subjectivity (threshold for item endorsement)

    2. Problems with reliability (retest not bad, but only 60 % of items endorsed at one time are also endorsed at another).

    3. Problems with memory accessibility (fall off about 5 % per month).

    4. Problems with content validity.

    ONE PROPOSED SOLUTION: INVESTIGATOR-BASED METHODS


A key distinction between Investigator-Based (IB) and Self-Report (SR) Methods

  • In IB methods, the responsibility for identifying and rating severity of “stressors” lies with the investigator not with the respondent.

  • Final interpretation and ratings are made by trained staff /investigator in conjunction with the subject’s self-report. Severity ratings are based upon contextual circumstances surrounding each stressor (for example, pregnancy with or without stable family circumstances) and with the assistance of dictionary or coding manual, rather than upon respondent’s subjective reaction to the event in the course of its description.


Example of a checklist item serious illness of a close family member
Example of a checklist item: Self-Report (SR) Methods “Serious illness of a close family member”

  • How serious is “serious”

  • How close is “close”

  • What constitutes an “illness”

  • Who constitutes a “family member”


What is leds
What is LEDS? Self-Report (SR) Methods

* Life Events and Difficulties Schedule

(LEDS; Brown & Harris, 1979; 1989)

  • Semi-structured interview that allows one to identify current life stressors that threaten one’s goals and commitments, using behavioral indicators of threat (verbal or written job performance ratings) goal investment (primary vs. secondary wage earner). Severity ratings are based on the life circumstances of the individual.

    * LEDS is considered to be the “gold standard” of investigator-based assessment of life stress.


Stimulus-based model Self-Report (SR) Methods

  • LEDS

    • Calendar method

    • Multiple domains

    • “Dictionary” coding system

      Assumptions :

  • What makes stress stressful? Contextual threat= threat to important values and commitments.

  • Impact of events involves threshold model. Interrelated events are not double counted.

  • Effects of stress assumed to vary according to individuals’ biographical characteristics.


How do you implement leds
How do you implement LEDS? Self-Report (SR) Methods

Three part process:

1. Interview

2. Rating procedure

3. Consensus process


Why Use These Methods? Self-Report (SR) MethodsAdvantages

  • Checklists have demonstrated poor test-retest reliability.

  • IB methods allow greater precision in the consistent identification of stressors as well as their onset and offset.

    McQuaid et al. (1992) 62% of checklist- identified

    stressors were found to be discrepant with those identified by

    the LEDS.


Why not use these methods disadvantages
Why Not Use These Methods? Self-Report (SR) MethodsDisadvantages

  • Cost of implementation

    • Training is necessary

    • Respondent/investigator burden in terms of time and effort for administration is considerable

    • Rating and independent review of ratings can be lengthy

  • Research considerations

    • Not widely used in the literature because of cost and training

    • Extant evidence supporting their use in terms of predictive validity is limited


Definitions of stress4
DEFINITIONS OF STRESS Self-Report (SR) Methods

  • Response-based model

  • (Selye, 1974) “Stress is the nonspecific response of the body to any demand made upon it.”

  • Stimulus-based model

  • (Holmes & Rahe, 1967) Stress involves “…events whose advent…requires a significant change in the ongoing life pattern of the individual.”

  • Transactional model

  • (Holroyd & Lazarus, 1982) Stress involves the “judgment that environmental or internal demands tax or exceed the individual’s resources for managing them.”


Definitions of stress5
DEFINITIONS OF STRESS Self-Report (SR) Methods

  • Transactional model

  • (Holroyd & Lazarus, 1982) Stress involves the “judgment that environmental or internal demands tax or exceed the individual’s resources for managing them.”

  • ASSUMPTIONS:

    • Stress involves balance between demands and resources.

    • The mechanism by which these are compared involves a judgment or a cognitive appraisal process.


DEFINITIONS OF STRESS Self-Report (SR) Methods

  • Transactional Model

    Primary Appraisal “What is at stake?”

    Secondary Appraisal “Can I cope?”


DEFINITIONS OF STRESS Self-Report (SR) Methods

  • Transactional Model

  • Appraisal as “final common pathway by which diverse personal and environmental variables influence the outcomes of stressful encounters.”

  • Transactional model

person

environment


Perceived Stress Scale Self-Report (SR) MethodsCohen, Kamarck & Mermelstein (1983). J Health and Soc Bhr, 24, 386-96.

2. In the last month, how often have you felt that you were unable to control the important things in your life?

6. In the last month, how often have you felt confident about your ability to handle your personal problems?

7. In the last month, how often have you felt that things were going your way?

14. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?


DEFINITIONS OF STRESS Self-Report (SR) Methods

  • Transactional Model

STRENGTHS

Takes into consideration individual differences in perception or appraisal.

WEAKNESSES

Confounded with a number of dimensions, such as depressive symptoms and neuroticism, which may be important to disaggregate from the construct of stress.


Cognitive Appraisal and the Brain Self-Report (SR) Methods

Joseph LeDoux

Cognitive appraisal may not be necessary in order for

a stimulus to elicit an emotional response that alters

the physiology of the organism.


THE TEMPORAL DIMENSION Self-Report (SR) Methods

ACUTE

CHRONIC

RESPONSE-BASED

STIMULUS-BASED

TRANSACTION


The challenge of exposure assessment
THE CHALLENGE OF EXPOSURE ASSESSMENT Self-Report (SR) Methods

  • As with other environmental risk factors (e.g., passive smoking, radiation) the impact of psychosocial stress on health should be expected to vary as a function of the frequency, duration, or intensity of daily exposure.

  • Documenting the extent of environmental risk exposure (not just intensity but also frequency and duration) is a challenge for epidemiologists who study the risk factors related to disease, and all the more so when such risk factors involve psychosocial processes.

  • When it comes to the measurement of psychosocial stress, we have not yet adequately addressed this challenge.


EXPOSURE Self-Report (SR) Methods

BIOLOGY

PROGRAM

  • Enhance our ability to assess environmental exposures (e.g., environmental and chemical toxins) that may interact with genetic propensities to influence health

  • environmental toxins, drugs & chemical agents, nutritional factors, physical activity, psychosocial stress.

Common Denominator:Frequency and duration of exposure to these factorsmay be difficult to assess using standard methods.


THE CHALLENGE OF EXPOSURE ASSESSMENT Self-Report (SR) Methods

  • INVESTIGATOR-BASED INTERVIEW APPROACH

  • Accuracy in assessment of stressor onset ,

  • offset using objective criteria

  • duration of stressor exposure.

ECOLOGICAL MOMENTARY ASSESSMENT

  • Ability to collect representative time samples frequency and duration of exposure.


THE TEMPORAL DIMENSION Self-Report (SR) Methods

CHRONIC

RESPONSE-BASED

ECOLOGICAL MOMENTARY ASSESSMENT

EMA

INVESTIGATOR-BASED

INTERVIEW APPROACH

STIMULUS-BASED

TRANSACTION


THE CHALLENGE OF EXPOSURE ASSESSMENT Self-Report (SR) Methods

  • INVESTIGATOR-BASED INTERVIEW APPROACH

  • Accuracy in assessment of stressor onset ,

  • offset using objective criteria

  • duration of stressor exposure.

  • Life Events and Difficulties Schedule (LEDS) (Brown & Harris, 1989).

    • --chronic “difficulties” as well as acute events

    • --extensive training, administration & scoring time


LIFE EVENTS ASSESSMENT PROFILE (LEAP) Self-Report (SR) Methods

Barbara Anderson (Pitt) and Elaine Wethington (Cornell University)

  • --maintained contextual assessment features of LEDS.

  • --maintained calendar methods for determining onset, offset of chronic stressors that takes into consideration fluctuation in magnitude of effects over time.

  • -- Extracted key contextual features of stressors imbedded in coding system of LEDS: structured behavior-specific probes.


LIFE EVENTS ASSESSMENT PROFILE (LEAP) Self-Report (SR) Methods

Computer Assisted Personal Interview (CAPI) system with relational database features


LIFE EVENTS ASSESSMENT PROFILE (LEAP) Self-Report (SR) Methods

  • 10 different life domains in LEAP, skip patterns can be quite complex.

  • Relational database features will allow us to interact with calendar system, updated throughout the interview, allowing us to characterize the onset, offset of events and difficulties across domains.

  • Use of computerized algorithms for navigating through interview is expected to result in considerable time savings in interview administration.

  • Automated and instantaneous scoring of protocol will eliminate need for scoring, consensus meetings, further reducing time requirements.


LIFE EVENTS ASSESSMENT PROFILE (LEAP) Self-Report (SR) Methods

  • CAPI will permit us to administer the LEAP by phone.

  • One of first attempts to develop automated administration system for comprehensive interview assessment of life stressors.


THE CHALLENGE OF EXPOSURE ASSESSMENT Self-Report (SR) Methods

ECOLOGICAL MOMENTARY ASSESSMENT

  • Ability to collect representative time samples frequency and duration of exposure.

Assumption: Chronic stress leaves its

signature on the behavioral and biological

events of our daily lives.

Limitations of autobiographical memory for

reconstructing frequency, duration of daily events

(Bradburn et al., 1987).


Ecological momentary assessment ema approach to the assessment of psychosocial stress
ECOLOGICAL MOMENTARY ASSESSMENT (EMA) APPROACH TO THE ASSESSMENT OF PSYCHOSOCIAL STRESS

RATIONALE

  • EMA measures may allow us to more accurately capture the frequency and duration of psychosocial stress “exposure” as it pertains to our daily experience.

  • EMA measures allow us to examine mechanistic hypotheses linking stress with disease– can be linked with moment-to-moment changes in biological processes, e.g., endocrine or hemodynamic activity.

  • EMA measures allow us to examine the importance of setting effects relevant to the occurrence and consequences of stress (e.g., social interactions with partner vs. others; health effects of job demands vs. household demands vs. neighborhood demands).


Five psychological processes linked with stress acute cardiovascular activation and disease risk
Five psychological processes linked with stress, acute cardiovascular activation, and disease risk

  • NEGATIVE AFFECT

  • AROUSAL

  • TASK DEMAND

  • TASK CONTROL

  • SOCIAL CONFLICT

Kamarck et al. (1998). Health Psychology, 17, 17-29.


  • KARASEK JOB CONTENT QUESTIONNAIRE cardiovascular activation, and disease risk

  • Psychological Demands

  • My job requires working very fast.

  • My job requires working very hard.

  • I am not asked to do an excessive amount of work. (R)

  • I have enough time to get the job done. (R)

  • I am free from conflicting demands that others make. (R)

  • Decision Latitude e.g.,

  • My job allows me to make a lot of decisions on my own.

  • 2. On my job, I have very little freedom to decide how I do my work.(R)

  • 3. I have a lot of say about what happens on my job.(R)


TASK DEMAND cardiovascular activation, and disease risk

Activity last 10 minutes

Required working hard?

NO==================YES

Required working fast?

NO==================YES

Juggled several tasks at once?

NO==================YES

Adapted from Karasek Job Content Questionnaire

DECISIONAL CONTROL

Activity last 10 minutes

Could change activity if you chose to?

NO==================YES

Choice in scheduling this activity?

NO==================YES


TABLE 1. cardiovascular activation, and disease risk

DIARY RATINGS AT HOME AND WORK (n = 176)

Home Worktp

Task Demand 3.97 5.60 15.36 .0001

Dec Control 8.22 6.76 -10.50 .0001

Negative Affect 3.45 3.61 3.15 .0019

Arousal 7.41 8.40 15.24 .0001

Social Conflict 2.64 2.61 -.64 .5215


Five psychological processes associated with moment to moment changes in blood pressure
Five psychological processes associated with moment-to-moment changes in blood pressure

SBPp

  • NEGATIVE AFFECT .38 .0001

  • AROUSAL .54 .0001

  • TASK DEMAND .18 .0003

  • TASK CONTROL -.09 .02

  • SOCIAL CONFLICT.41 .0001

Kamarck et al. (2002). Physiology and Behavior, 77, 699-704.


TABLE 2. moment-to-moment changes in blood pressure

FOUR MONTH TEST-RETEST RELIABILITY OF DIARY SUBSCALES (N = 354)

rp

Task Demand .73 .0001

Dec Control .70 .0001

Negative Affect .75 .0001

Arousal .76 .0001

Social Conflict .73 .0001


GLOBAL VS. MOMENTARY RATINGS moment-to-moment changes in blood pressure

OF DEMAND AND CONTROL (N=152)

Global Job RatingsDemandControl

Mean Momentary Ratings at Work

Demand r =.53 *** ----

Control ---- .31***

*** < .0001


Aggregated over 6-day period, mean ratings of Task Demand and Task Control associated with chronic elevations of blood pressure during daily life

Kamarck et al. (2002).

Physiology and Behavior,

77, 699-704.

Mean Task Demand / Mean Task Control


Mean ratings of Task Demand and Task Control related in the expected direction with measures of carotid artery atherosclerosis

Kamarck et al. (2004). Health Psychology, 23, 24-32.

b=.02, F (1, 328) = 8.44, r2 = .02, p =.004


Mean ratings of Task Demand and Task Control expected direction with measures of carotid artery atherosclerosis

related in the expected direction with measures of

carotid artery atherosclerosis

  • Global questionnaire measures of Psychological Demands and Decision Latitude (JCQ) were not significantly correlated with mean IMT.

  • e.g., Demands (b=.00, p=.59, r2= .00).

Kamarck et al. (2004) Health Psychology, 23, 24-32.


Mean ratings of Task Demand and Task Control expected direction with measures of carotid artery atherosclerosis

related in the expected direction with measures of

carotid artery atherosclerosis

  • Task Demand ratings were associated with atherosclerosis even among those who were not employed during the study (n=141).

  • (b=.02, p=.03, r2= .03).

  • Among employed Ss (n=152), association did not differ as a function of whether ratings were derived from inside or outside of the workplace.

  • Work: (b=.02, p=.02, r2= .03).

  • Nonwork: (b=.02, p=.05, r2= .02).


Mean ratings of Task Demand and Task Control related in the expected direction with measures of carotid artery atherosclerosis

Kamarck et al. (2007). Health Psychology, 26, 324-332.


Ecological momentary assessment ema approach to the assessment of stress
ECOLOGICAL MOMENTARY ASSESSMENT (EMA) APPROACH TO THE ASSESSMENT OF STRESS

Conclusion: There may be some important utility to this new assessment approach as a means of understanding how the cumulative effects of chronic psychosocial stress impact on health outcomes over the course of daily living.


THE CHALLENGE OF “EXPOSURE ASSESSMENT” ASSESSMENT OF STRESS

ECOLOGICAL MOMENTARY ASSESSMENT

  • Ability to collect representative time samples frequency and duration of exposure.

  • Our contribution at this point:

  • Development of more user-friendly assessment technologies.

  • Refine our elaborate upon our measures, in order

  • to be able to best characterize the types of daily stressors

  • that are strongest triggers for biological systems thought

  • to enhance our susceptibility to disease.


e-Watch ASSESSMENT OF STRESS

(Siewiorek, Smailagic)

Human Computer Interaction Institute (HCII, CMU)


E-WATCH ASSESSMENT OF STRESS

In contrast to standard PDA, more flexible in terms of number of input, output, and prompting modalities available.

  • Interview presentation:

    visual (watch face)

    auditory (earbug)

  • Responses:

    manual (button push on watch)

    speech (earbug phone)

    gestural (accelerometer in watch)


E-WATCH ASSESSMENT OF STRESS

We are in process of examining

  • relative advantages of e-watch over PDA

    (user satisfaction and compliance)

  • relative merits of each of these input and output modalities under various situations and for those (low literacy, manual laborers) assumed to have difficulty with “traditional” PDA assessments.


OUR GOALS IN THE YEARS AHEAD ASSESSMENT OF STRESS

EXPOSURE

BIOLOGY

PROGRAM

  • Phase 1 (Year 1)

    Development of testing devices for each of these two methods.

  • Phase 2 (Year 2-3)

    Item analysis and validation of instrument content.

  • Phase 3 (Year 3-4)

    Cross validation and reliability testing.

  • Phase 4 (Year 4)

    Documentation, standardized training procedures, manufacturing plans.


  • EXPOSURE ASSESSMENT OF STRESS

  • BIOLOGY

  • PROGRAM

  • University of Pittsburgh

  • Computer-assisted technologies for tracking exposure to psychosocial stress.

  • Johns Hopkins & NIDA

  • Real-time assessment of individual and neighborhood exposure to drugs and stress using hand-held electronic diaries and position technology (Kirk, Preston)

  • University of Memphis

  • Wireless skin patch sensors to dtect and transmit addiction and psychosocial stress data (Kumar)

  • Rensselear Polyutechnic Institute

  • A personal light-monitoring device for reducing psychosocial stress (Rea)

  • UCLA

  • Handheld salivary biosensor of psychosocial stress (Shetty)

  • MIT

  • Enabling population-scale physical activity and experience sampling measurement on common mobile phones (Intille)



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