An introduction to the 'Psycho-Physiological-Stress-Test' (PPST)-A standardized instrument for evaluating stress reactions.

Elisabeth Neureiter,Matthias Rose,Anne Ahnis,Gerhard Danzer,Annett Mierke,Loreen Hajfani,Burghard F Klapp,Xianwu Cheng

doi:10.1371/journal.pone.0187859

Abstract

Using a standardized instrument to evaluate patients’ stress reactions has become more important in daily clinical routines. Different signs or symptoms of stress are often unilaterally explored: the physiological, psychological or social aspects of stress disorders are each viewed on a single dimension. However, all dimensions afflict patients who have persistent health problems due to chronic stress. Therefore, it is important to use a multidimensional approach to acquire data. The ‘Psycho-Physiological-Stress-Test’ (PPST) was established to achieve a comprehensive understanding of stress and was further developed at the Charité—Universitätsmedizin Berlin in collaboration with the Psychological Department of Freie Universität Berlin. The PPST includes a series of varying stress phases, embedded in two periods of rest. Physiological and psychological parameters are simultaneously measured throughout the test session. Specifically, the PPST activates the sympathetic stress axis, which is measured by heart rate, blood pressure, respiration depth and rate, electro dermal activation and muscle tension (frontalis, masseter, trapezius). Psychological data are simultaneously collected, and include performance, motivation, emotion and behavior. After conducting this diagnostic test, it is possible to identify individual stress patterns that can be discussed with the individual patient to develop and recommend (outpatient) treatment strategies. This paper introduces the PPST as a standardized way to evaluate stress reactions by presenting the results from a sample of psychosomatic inpatients (n = 139) who were treated in Charité—Universitätsmedizin Berlin, Germany. We observed that the varying testing conditions provoked adjusted changes in the different physiological parameters and psychological levels.

Highlights

Given the problems with the psychophysiological discipline’s multidisciplinary approach, we present an economical stress test for evaluating stress reactions in the clinical routine
We found no significant differences between our study sample and all other inpatients during this study’s time period on the ‘Patient Health Questionnaire’ (PHQ) [18]; the ‘Perceived Stress Questionnaire’ (PSQ) [19]; and the COPE [20]
We found that the different testing conditions provoked adjustments at the different psychological levels (Tables 2 and 5)

Summary

Introduction

Given the problems with the psychophysiological discipline’s multidisciplinary approach, we present an economical stress test for evaluating stress reactions in the clinical routine. Patients who suffer from body related complaints, in the context of psychosocial distress, are often referred to a psychosomatic expert after several years. Many clinical studies have experimentally verified that stress affects individual’s physiological and psychological systems [6,7,8,9]. In 1975, Selye [11] differentiated between ‘dis- and eustress’, or pathological stress (negative, distress) vs health-promoting stress (positive, eustress). Distress leads to (severe) physiological and psychological health problems, eustress has beneficial outcomes, including the ability to adjust to new situations or focus on solving problems, for example, at work [12]. It is important to assess a wide range of physiological and psychosocial parameters when studying individuals’ stress reaction(s)

Methods

Results

Conclusion