The Pittsburg Stress Battery (PSB) is a standardized means of evaluating cardiovascular (CV) reactions as a response to acute stressors which have been linked to an increased risk for cardiovascular disease. It was developed at the University of Pittsburg School of Medicine’s Psychiatric Institute. The original protocols vary but normally consisted of three tasks designed to maximize various psychological demands: a visual short term memory task (scanning), an accuracy evaluation (targeting), and a cognitive motor/reflex task (tracking). For example, the original protocol was designed to require participants use minimal motor skills tasks were completed on a joystick or keypad. The protocol consisted of (1) identifying the placement of a series of dots after they vanish from the screen (scanning) (2) shooting and hitting a target moving across the top of the computer screen (targeting) (3) moving the cursor over a specified area with directional commands reversed (tracking). Additionally, the battery has been modified in various trials, for example, by including The Stroop Task (see this task listed separately in this same Measures Repository), arithmetic task evaluations, and/or cold-pressor experiences. Although tests may vary, all task batteries are designed with the goal of increasing a participant’s CV reactions. Between each task participants are allowed a resting period. Between each task participants are allowed a resting period in some protocols they are asked to participate in a minimally invasive task designed to elicit stable cardiovascular measures between testing including minimally cognitively invasive questionnaires. Multiple measures of cardiovascular reactivity are administered during each test and have included continuous heart rate measures using electrocardiogram (EKG) devices, measures of preejection period (PEP) elicited through evaluation of cardiograph waveforms as well as discrete measures of systolic blood and diastolic blood pressure.
The Pittsburg Stress Battery (PSB) is a test of cardiovascular activation/reactivity, which has been linked to exaggerated CV risk factors and outcomes specifically hypertension, coronary heart disease, and myocardial infarction. This link is known as the reactivity hypothesis [1, 2-5]. However, the measures used to assess CV reactivity ranged significantly from cognitive tasks to isometric exercises, pain challenges, and stress-inducing interpersonal experiences . In an effort to more effectively measure the determinants of this link, researchers applied three core principles of psychometric theory. First, items were selected in order to discriminate the greatest number of responses and increase test score dispersion. Second, tests were evaluated for their ability to minimize sources of variance. Third, longer tests were considered more reliable . The resulting protocol was founded in cognitive-focused tasks, since they were believed to elicit moderate levels of response, as well as minimized non-verbal administration of tasks, as verbally founded tasks were hypothesized to introduce additional variance into the measure. To conform to the third principle, the test was designed as a three-item test battery (i.e. tracking, psychomotor task; target, reaction-time task; and scanning, memory task), which allowed for a longer, multiple-item test protocol . The protocol has been used in more recent research to corroborate the original findings associating CVD reactivity with measurable health outcomes, including atherosclerosis, myocardial infarction, increased left ventricular mass, and coronary heart disease mortality [7, 8-16]. In addition, CVD and stress reactivity may be indicative of maladaptive coping behaviors with studies demonstrating that individuals high in stress reactivity may be more inclined to engage in over consumption of palatable foods, smoking or high levels of sedentary activities (i.e. electronic screen use)[17-20].
[+] PMCID, PUBMED ID, or CITATION
Text Citation: 1. Kamarck, T.W., T.T. Debski, and S.B. Manuck, Enhancing the laboratory-to-life generalizability of cardiovascular reactivity using multiple occasions of measurement. Psychophysiology, 2000. 37(4): p. 533-42.
Text Citation: 2. Obrist, P.A., Cardiovascular psychophysiology: a perspective. 1981, New York: Plenum Press.
Text Citation: 3. Manuck, S.B., Cardiovascular Reactivity in Cardiovascular Disease: 'Once More Unto the Breach'. International Journal of Behavioral Medicine, 1994. 1(1): p. 4.
Text Citation: 4. Kamarck, T.W., et al., Correspondence between laboratory and ambulatory measures of cardiovascular reactivity: a multilevel modeling approach. Psychophysiology, 2003. 40(5): p. 675-83.
Text Citation: 5. Figueredo, V.M., The time has come for physicians to take notice: the impact of psychosocial stressors on the heart. Am J Med, 2009. 122(8): p. 704-12.
Text Citation: 6. Kamarck, T., Recent developments in the study of cardiovascular reactivity: Contributions from psychometric theory and social psychology. Psychophysiology, 1992. 29(5): p. 491-503.
Text Citation: 7. Phillips, A.C. and B.M. Hughes, Introductory paper: Cardiovascular reactivity at a crossroads: Where are we now? Biological Psychology, 2011. 86(2): p. 95-97.
Text Citation: 8. Allen, M.T., A.J. Boquet, and K.S. Shelley, Cluster analyses of cardiovascular responsivity to three laboratory stressors. Psychosomatic Medicine, 1991. 53(3): p. 272-288.
Text Citation: 9. Barnett, P.A., et al., Psychological stress and the progression of carotid artery disease. JOURNAL OF HYPERTENSION, 1997. 15(1): p. 49-55.
Text Citation: 10. Jennings, J.R., et al., Exaggerated blood pressure responses during mental stress are prospectively related to enhanced carotid atherosclerosis in middle-aged Finnish men. Circulation, 2004. 110(15): p. 2198-203.
Text Citation: 11. Everson, S.A., et al., Anticipatory blood pressure response to exercise predicts future high blood pressure in middle-aged men. HYPERTENSION, 1996. 27(5): p. 1059-1064.
Text Citation: 12. Kamarck, T., et al., Exaggerated blood pressure responses during mental stress are associated with enhanced carotid atherosclerosis in middle-aged Finnish men - Findings from the Kuopio Ischemic Heart Disease Study. CIRCULATION, 1997. 96(11): p. 3842-3848.
Text Citation: 13. Lynch, J.W., et al., Does low socioeconomic status potentiate the effects of heightened cardiovascular responses to stress on the progression of carotid atherosclerosis? Am J Public Health, 1998. 88(3): p. 389-94.
Text Citation: 14. Matthews, K.A., et al., Blood pressure reactivity to psychological stress and coronary calcification in the coronary artery risk development in young adults study. HYPERTENSION, 2006. 47(3): p. 391-395.
Text Citation: 15. Murdison, K.A., et al., Prediction of left ventricular mass in youth with family histories of essential hypertension. Am J Med Sci, 1998. 315(2): p. 118-23.
Text Citation: 16. Treiber, F.A., et al., Cardiovascular reactivity and development of preclinical and clinical disease states. Psychosomatic Medicine, 2003. 65(1): p. 46-62.
Text Citation: Emmons, K.M., G. Weidner, and R.L. Collins, Smoking cessation and cardiovascular reactivity to stress. J Behav Med, 1989. 12(6): p. 587-98.
Text Citation: Ward, M.M., et al., Effect of smoking cessation and relapse on cardiovascular levels and reactivity. Psychopharmacology (Berl), 1994. 114(1): p. 147-54.
Text Citation: McKee, S.A., et al., Stress decreases the ability to resist smoking and potentiates smoking intensity and reward. J Psychopharmacol, 2011. 25(4): p. 490-502.
Text Citation: Stults-Kolehmainen, M.A. and R. Sinha, The Effects of Stress on Physical Activity and Exercise. Sports Medicine, 2014(44): p. 81-121.
Evaluating the Pittsburgh Stress Battery represents a challenge as the protocol consists of a variety of stress inducing tasks ranging from cognitive, interpersonal and physically challenging items. Preliminary validity analyses investigated the reliability of cardiovascular measures over time in response to the testing protocol. Analyses were conducted with 4 different samples a group of community females (N=29) a group of community males (N=42) a group of college males (N=21) and a group of black and Caucasian community females (N=30). The protocol consisted of three item test battery (targeting, scanning, & tracking) test retest coefficients across cardiovascular reactivity measures were evaluated at a maximum of 6 points across the test. All internal reliability coefficients for heart rate (α =0.93, p=<0.05), systolic blood pressure(α =0.92, p=<0.05) and diastolic blood pressure (α =0.93, p=<0.05) were significant in the female community sample (N=29). Test-retest coefficients for this sample were also significant across heart rate (α =0.69, p=<0.05), systolic (α =0.60, p=<0.05), and diastolic blood pressure (α =0.56, p=<0.05) . Concern has been expressed for the criterion validity of the PBS or the application of results derived from a controlled setting (i.e. laboratory designated for PBS) and real world settings . The two strategies currently used to investigate the effects of laboratory to field studies are (1) laboratory studies compared with ambulatory BP during unprompted periods of the day and (1) laboratory results compared with responses occurring naturally in stressful life situations [3, 4]. The results of these studies are modest and “inconsistent across tasks and parameters” for example one review article summarized that only 20-25% of the hypothesized comparisons demonstrating any level of significance across the expected direction [5, 6]. However, these studies suffered from numerous methodological limitations including a need to consider multilevel modeling when evaluating ambulatory BP in relation to laboratory averages and consistently evaluating laboratory and field reactivity against only one stimulus as opposed to aggregating over multiple stimuli . In an effort address the generalizability considerations Kamarck and colleagues conducted a field task consisting of 2 classroom speech evaluations, each evaluated twice per period for CVD response, against 6 laboratory testing sessions (evaluated once per task for CVD response) conducted twice per participant resulting in 48 correlations for each CV measure, in this study heart rate (HR) systolic blood pressure (SBP) and diastolic blood pressure (DBP) . Results of task aggregated responses, derived from both evaluating between tasks as well across session periods, demonstrated modest correlations across between laboratory and field tests for heart rate (r = 0.30, p< .05) systolic blood pressure (r =0.26, p< .05) and diastolic blood pressure (r = 0.40, p<.01) demonstrating that participants who had increased CV reactivity to laboratory challenges also had increased reactivity to field tests [5,6].
[+] PMCID, PUBMED ID, or CITATION
Text Citation: 1. Kamarck, T.W., et al., Reliable measures of behaviorally-evoked cardiovascular reactivity from a PC-based test battery: results from student and community samples. Psychophysiology, 1992. 29(1): p. 17-28.
Text Citation: 2. Phillips, A.C. and B.M. Hughes, Introductory paper: Cardiovascular reactivity at a crossroads: Where are we now? Biological Psychology, 2011. 86(2): p. 95-97.
Text Citation: 3. Turner J, W.M., Gellman M, Johnston D, Light K, Van Doornen L., The relationship between laboratory and ambulatory cardiovascular activity: current evidence and future directions. Ann Behav Med 1994(16): p. 12-23.
Text Citation: 4. Van Doornen, L.J. and R.W. Van Blokland, The relationship between cardiovascular and catecholamine reactions to laboratory and real-life stress. Psychophysiology, 1992. 29(2): p. 173-181.
Text Citation: 5. Kamarck, T.W., T.T. Debski, and S.B. Manuck, Enhancing the laboratory-to-life generalizability of cardiovascular reactivity using multiple occasions of measurement. Psychophysiology, 2000. 37(4): p. 533-42.
Text Citation: 6. Kamarck, T.W. and W.R. Lovallo, Cardiovascular reactivity to psychological challenge: conceptual and measurement considerations. Psychosom Med, 2003. 65(1): p. 9-21.
The original study provides minimal descriptors for the population simply stating that reliability was assessed using 24 participants all male at two time points separated by two weeks. . Follow-up validation studies were administered to: a community sample of 29 women and 3 additional samples consisting of (1) college males (N=21), community males (N=42) and community black and Caucasian/ white females (N=30) . Further analysis was conducted on 4 cohorts of Finnish men enrolled in Kuopio Ischemic Heart Disease study. Of the 2,682 participants enrolled N=756 (42-60 years old) men elected to participate in the cross sectional analysis.
More recent efforts have been undertaken to establish laboratory to life validity of the PSB. One study consisted of college undergraduate students (N=60) ages 18-28 years old .
1. Debski, T.T., et al., A computerized test battery for the assessment of cardiovascular reactivity. Int J Biomed Comput, 1991. 27(3-4): p. 277-89.
This measure has not been influenced yet.
This measure has not been validated yet.
|Cardiovascular Reactivity; The "Pittsburgh Battery"||Visit Link|
The Science of Behavior Change (SOBC) program seeks to promote basic research on the initiation, personalization and maintenance of behavior change. By integrating work across disciplines, this effort will lead to an improved understanding of the underlying principles of behavior change. The SOBC program aims to implement a mechanisms-focused, experimental medicine approach to behavior change research and to develop the tools required to implement such an approach. The experimental medicine approach involves: identifying an intervention target, developing measures to permit verification of the target, engaging the target through experimentation or intervention, and testing the degree to which target engagement produces the desired behavior change.
Within the SOBC Measures Repository, researchers have access to measures of mechanistic targets that have been (or are in the processing of being) validated by SOBC Research Network Members and other experts in the field. The SOBC Validation Process includes three important stages of evaluation for each proposed measure: Identification, Measurement, and Influence.
The first stage of validation requires a measure to be Identified within the field; there must be theoretical support for the specific measure of the proposed mechanistic target or potential mechanism of behavior change. This evidence may include references for the proposed measure, or theoretical support for the construct that the proposed measure is intended to assess. The second stage of validation requires demonstration that the level and change in level of the chosen mechanistic target can be Measured with the proposed measure (assay). For example, if the proposed measure is a questionnaire, the score on the measure should indicate the activity of the target process, and it must have strong psychometric properties. The third stage of validation requires demonstration that the measure can be Influenced; there must be evidence that the measured target is malleable and responsive to manipulation. Evidence relating to each stage includes at least one peer-reviewed publication or original data presentation (if no peer-reviewed research is available to support the claim) and is evaluated by SOBC Research Network Members and experts in the field.
Once a measure has gone through these three stages, it will then either be Validated or Not validated according to SOBC Research Network standards. If a measure is Validated, then change in the measured target was reliably associated with Behavior Change. If a measure is Not validated, then change in the measured target was not reliably associated with Behavior Change. Why would we share measures that are not validated? The SOBC Research Network values open, rigorous, and transparent research. Our goal is to make meaningful progress and develop replicable and effective interventions in behavior change science. Therefore, the SOBC sees value in providing other researchers in the field with information regarding measures that work and measures that fall short for specific targets. Further, a measure that is not validated for one target in one population may be validated in another target or population.
Want to learn more? For any questions regarding the SOBC Validation Process or Measures Repository, please email firstname.lastname@example.org.
Has the mechanism been identified as a potential target for behavior change? This section summarizes theoretical support for the mechanism.
Have the psychometric properties of this measure been assessed? This section includes information such as content validity, internal consistency, and test-retest reliability.
Has a study manipulation led to change in the mechanism? This section addresses evidence that this measure is modifiable by experimental manipulation or clinical intervention.
Has a change in this mechanism been associated with behavior change? This section addresses empirical evidence that causing change in the measure reliably produces subsequent behavior change.