Affect (Mood States) Assessment

In psychology, the term mood refers to a person’s emotional state. Mood is central to psychological health, and disturbances in mood are related to subsequent psychological maladjustment. Moods such as elation, joyfulness, and excitement, when experienced within normal ranges, enhance a person’s life and are associated with well-being. Moods such as anger, hostility, depression, and mania are negative emotions. When these moods are experienced outside of the normal range or when a person no longer has control over these moods, psychological disturbances appear in behavior. While it is normal for persons to experience anger, irritation, or sadness based on external events, these emotions can become extreme, leading to the need for psychological intervention.

A client’s mood permeates almost any aspect of psychological intervention, and hence a reliable assessment of mood is part of the psychologist’s armamentarium. The most common methods of assessing mood are the clinical interview and the use of a self-report inventory, but some psychologists use projective tests to assess mood. Although there are psychologists who tend to rely on their own clinical judgments and avoid more formal assessments, a formal and organized assessment typically provides more accurate information than interviewing a patient in an unstructured manner. A systematic assessment evaluates all aspects of mood, whereas an unstructured assessment guided by clinical judgment can become sidetracked on a particular line of inquiry and fail to assess all aspects of the problem.

This entry reviews the instruments and scales most commonly used by psychologists to assess disturbances in mood. Some of these use a true/false format, others have a checklist format, and still others have a multiple-choice format, but the format is less important than the range of content included in the instrument. Some of these instruments are referred to as broad-band instruments because they assess a variety of emotions. Others are referred to as narrow-band tests, signifying that they assess only a single specific mood.

When assessing moods, psychologists consider whether the respondent is reporting honestly or is faking a response (i.e., exaggerating or underreporting his or her problems and emotional state). Inaccurate or “faked” responses are more likely when an evaluation is conducted to decide about employment, child custody, or prison release, or to obviate or attenuate a court verdict.

Some tests and scales include items that are both obvious and subtle to control for faking. An obvious item is one where the content of the item is logically related to the mood being assessed. For example, “I feel blue most of the time” is an obvious item when assessing depression. A respondent motivated to fake a response could do so easily on such an item. However, if research has found that depressed respondents often answer, “False” to the item “I like to eat candy,” the item is not obviously related to depression (i.e., provides a subtle assessment of depression). In general, tests and scales that have ways to detect tendencies toward inaccurate or inconsistent responding are more valid than those without such means.

Finally, psychologists evaluate the psychometric properties of tests and scales prior to using an instrument. Psychometric properties refer to the reliability, validity, internal structure, and correlations with external behavior of scores on the scale. All of the measures reviewed in this article have acceptable reliability and validity.

The temporal reliability of an instrument is particularly important when assessing mood, because the respondent’s score at different times is often important. If the construct is a trait, temporal stability is expected. If the construct is a mood, the pattern of change provides information about the improvement or lack of change in the emotional state.

Methods of Assessing Mood

The most common way to assess mood is the clinical or assessment interview. Mood is an element in the overall assessment process in almost every published recommendation on interviewing and is a routine part of both a psychiatric and a mental status examination. These can be structured clinical interviews or “naturalistic” interviews. The latter are more commonly referred to as unstructured interviews, in which the psychologist talks with the client about a variety of topics and in so doing ascertains the level of mood (also referred to as affect).

Two types of structured interviews have been published. In a structured clinical interview, such as the Structured Clinical Interview for DSM-IV, the psychologist asks a predetermined set of questions. No additional questions are permitted. The client’s responses are scored according to diagnostic criteria. In a semi-structured clinical interview, such as the Structured Interview for DSM-IV Personality, the psychologist asks a set of predetermined questions, but supplements them with unscripted follow-up questions—referred to as probes—to gain a more complete understanding of the client’s response. In conducting an unstructured or semistructured interview, psychologists also take into account the client’s body language.

A clinical interview may appear to be unstructured because the psychologist does not appear to ask a set of predetermined questions. Nevertheless, the skilled interviewer will make sure to ask questions about each of the areas regarded as relevant to the question, problem, or disorder at hand.

There are many published self-report inventories that assess mood. Following is an overview of some of the more popular broad-band and narrow-band instruments that assess moods that have particular relevance to client functioning and behavior (i.e., anxiety, depression, mania, and hostility).

Broad-Band Mood Survey

The Guilford Zimmerman Temperament Survey (GZTS) is a 300-item self-report survey designed for use with individuals 16 years of age and older who have at least an eighth-grade education. It takes from 30 to 60 minutes to complete and can be scored via local software, mail-in scoring, or optical scan scoring. It provides scores on 10 aspects of personality and temperament (e.g., energy versus inactivity, impulsivity versus restraint, friendliness versus hostility, and stability versus irritability). A computer-derived interpretive report is available from the publisher. The GZTS was designed for use in counseling, career planning, personnel selection, and placement with nonclinical populations.

Broad-Band Measures of Anxiety

The scales discussed below are embedded in larger instruments. They are rarely extracted from the parent instrument for administration independent of the larger test.

Anxiety-Related Scales From the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)

Four scales of the MMPI-2 assess the respondent’s anxiety level—one clinical scale (Psychasthenia, or Pt), two content scales (Anxiety and Fears), and one supplemental scale (Welsh’s Factor A).

Psychasthenia is an older term that means neurotic anxiety, as opposed to realistic anxiety. It has been removed from psychiatric nomenclature, but the scale remains on the MMPI-2 as scale Pt. It is a 48-item scale that assesses trait anxiety, self-dissatisfaction, and psychic distress. The scale provides a reliable measure of both state anxiety (i.e., temporary anxiety due to some external circumstance) and trait anxiety (i.e., a lasting personality characteristic).

The Anxiety content scale consists of 23 items that assess physiological symptoms of anxiety (e.g., shortness of breath, sleep disturbances, and heart palpitations) and cognitive signs of anxiety (e.g., edginess, tension, and a fear that you are losing your mind). Persons who obtain a high score on this scale are described as ruminative, intellectualizing, and engaging in ritualistic behaviors. They often report problems with concentration, worry needlessly, and are troubled by disturbing thoughts. Scores on this scale are quite consistent when the test is administered more than once within a short period of time, such as a week.

The 23-item Fears content scale assesses apprehension about a particular object or circumstance and a fear of harm or injury. It has two components. The Generalized Fears component measures respondents’ feelings of persistent danger, and the potential harmfulness of objects or environmental circumstances. The Multiple Fears component assesses more specific fears such as fears of common objects or circumstances.

Welsh’s Factor A scale represents one of the primary components underlying responses to the MMPI-2. It assesses situational stress rather than generalized trait anxiety measured by the Pt scale, and is commonly interpreted as a measure of generalized anxiety. The scale is sometimes described as measuring lack of ego resiliency or general maladjustment.

Anxiety Clinical Scale From the Millon Clinical Multiaxial Inventory

The Anxiety Clinical Scale from the Millon Clinical Multiaxial Inventory (MCMI-III) contains a 14-item scale that correlates positively with items dealing with general distress and is useful in diagnosing patients with an anxiety disorder. Item content deals with nervous tension, intrusive thoughts (particularly over upsetting or traumatic events), sweating, compulsive behaviors, excessive worry, and fears of being alone. Persons scoring high on this scale have symptoms associated with physiological overarousal. They are described as anxious, apprehensive, restless, unable to relax, edgy, jittery, and indecisive. They often report symptoms that include insomnia, muscular tightness, headaches, nausea, cold sweats, undue perspiration, clammy hands, and palpitations. Phobias may or may not be present.

Anxiety Scale From the Personality Assessment Inventory

The Anxiety Scale from the Personality Assessment Inventory (PAI) scale measures the cognitive, affective, and physiological aspects of anxiety. PAI items deal with subjective feelings of apprehension, ruminative worries, and physical signs of tension and stress.

Anxiety-Related Scales From the Sixteen Personality Factors Questionnaire

The 5th revision of Raymond Cattell’s Sixteen Personality Factors (16 PF) contains two factor scales, Apprehension-(Factor O) and Tension-(Factor Q4), that measure anxiety and a secondary factor referred to as Anxiety. Elevations on the Apprehension scale describe a person who complains about excessive worries, apprehension, guilt, and insecurities. Elevations on the Tension scale describe someone who is tense, driven, and frustrated and feels overwrought. The Anxiety secondary factor includes items that assess emotional stability and vigilance.

Anxiety Scales From the Symptom Check-List-90 Revised

The Symptom Check-List-90 R (SCL-90-R) consists of a list of items that describe mood states (e.g., nervous, apprehensive). Respondents are instructed to check all of the items that describe them. The test is designed for use with adult patients and nonpatients and takes about 12 to 15 minutes to complete. The items are written at the sixth-grade reading level, and those on the anxiety scale assesses typical symptoms of anxiety, such as feelings of dread and terror, apprehension, tension, trembling, and general nervousness and panic. The Phobic Anxiety scale of the SCL-90-R measures persistent fears—of persons, places, objects, or situations—that are deemed irrational and that lead to avoidance or escape behaviors.

Narrow-Band Measures of Anxiety

Beck Anxiety Scale

The Beck Anxiety scale has 21 obvious items that are rated by the respondent on a 4-point scale. For example, the scale asks such questions as whether the respondent feels like a failure, cries a lot, or feels like killing him-or herself. Consequently, the scale is more susceptible to faking than are the scales mentioned above. Administration time is approximately 5 to 10 minutes.

Broad-Band Measures of Depression

The Depressive Adjective Check List

Adjective checklist methodology directs respondents to endorse an adjective if it describes them and to leave the item blank if it does not. Among the more popular instruments of this kind is the Depression Adjective Check List (DACL). The DACL was developed to measure transient moods, feelings, and emotions related to depression. It requires an eighth-grade reading level and has been translated into many foreign languages. There are several available lists to choose from with each list taking from 2 to 3 minutes to complete. Thus an assessment can be performed quickly and with minimal client resistance. Norms have been published for both depressed patients and normal individuals reporting no symptoms requiring attention. Items pertain to positive (e.g., happy) and negative (e.g., hostile) moods.

The Multiple Affect Adjective Check List-Revised (MACL-R) consists of 132 adjectives that ask respondents about their present state (i.e., “How do you feel today?”) and their more enduring trait (i.e., “How do you generally feel?”). It requires a sixth-grade reading level and measures both positive affect (e.g., friendliness, affectionate, and loving) and negative affect (e.g., anxiety, depression and hostility). It comes in two alternate forms.

These adjective checklists have the advantage of brevity and rapid administration. They consist of non-intrusive items that use words that are familiar to clients and a nonthreatening test format. They possess high face validity (i.e., they look like they are measuring what they claim to measure), and thus they stimulate little client test-taking resistance.

The Depression-Related Scales of the MMPI-2

Two scales of the MMPI-2 provide measures of depression. The Depression (D) clinical scale is a 57-item scale that contains items dealing with subjective depression, psychomotor retardation, physical malfunctioning, mental dullness, and brooding. The major theme in this scale is psychic distress. This scale is sensitive to mood changes—a feature that makes it useful for detecting actual variations in mood.

The Depression (DEP) content scale consists of 33 obvious items that deal with distressed mood. The scale items assess lack of drive, self-depreciation, exaggerated feelings of discontent, and suicidal ideation.

The D and DEP scales differ in the emphasis they give to different symptoms of depression. The items on D refer predominantly to vegetative symptoms (e.g., problems with lack of energy, sleep, and poor appetite). Items that ask about cognitive symptoms of depression (e.g., feeling like a failure, feeling useless, and feeling lonely) have a secondary role. Scale DEP does not contain any items dealing with vegetative symptoms. All of the items assess cognitive symptoms of depression such as feelings of worthlessness, inadequacy, and inferiority.

The Depression-Related Scales From the MCMI-III

The MCMI-III contains three scales that assess for problematic mood. The 14-item Dysthymia scale asks about the absence of pleasure, loss of energy, guilt feelings, sadness, changeable moods, and general disparagement. The 17-item Major Depression scale assesses loss of energy and appetite, problems sleeping, general fatigue, absence of pleasure, feelings of emptiness, intrusive memories, suicidal thoughts, admission of past suicide attempt(s), and reports of repression. Finally, the Bipolar: Manic scale contains 13 items dealing with overactivity, elation and inflatedness, flight of ideas, variable moods, overtalkativeness, and impulsivity. The Depressive Personality Disorder scale assesses a clinical personality pattern rather than mood, but there is much redundancy between the personality disorder and mood scales.

The Depression Scale of the PAI

The PAI Depression scale (24 items) is designed to measure clinical depression. Item content pertains to both cognitive symptoms (e.g., unhappiness, pessimism, apathy, and negativism) and physical symptoms (e.g., problems with sleep, appetite, and energy). There are three subscales dealing with cognitive, psychological, and affective aspects of depression.

The Depression Index From the SCL-90-R

The Depression scale from the SCL-90-R measures common symptoms of depression, such as lack of interest, lack of motivation (apathy), suicidal ideation, withdrawal, extreme discontent and negative affect, and various bodily symptoms of depression.

The Depression Index From the Rorschach Inkblot Test and Other Measures of Affect

The Rorschach inkblot test can be scored to yield scores that pertain to the affect of depression and one major index that assesses depression.

One ratio is the relationship of form-color responses to color-form and pure color responses. A form-color response is one that describes an object that has a distinct shape and which also uses color to describe the percept. An example would be “a yellow banana.” This measures controlled emotions. A color-form response is one where the object seen is dominated primarily by its color rather than by its form. An example would be “looks like a blue sky.” When the respondent refers only to the colors of the inkblot in forming the response, then a pure color response is scored. The last two types of responses measures impulsivity. The Affective ratio is the number of responses to the last three Rorschach cards compared to the number of response to the first seven cards. This measures the degree to which the client tends to become impulsive and drawn into emotional situations. Pure color is scored when the respondent only uses color to form the percept and indicates a failure to modulate an experienced emotion. Because many of the inkblots are black appearing on a white background, sometimes the respondent uses the white space rather than the black inkblot to form a response. This is called a space response. Space responses are scored when the test taker only uses this white space in the card to form the response. Depending on the frequency of occurrence, they can mean pessimism and negativism. The Depression Index (DEPI) clusters these and other scores into an overall index of depression. Since extensive training is required to reliably score and interpret the Rorschach, most psychologists use quicker and more objective means to assess mood.

Narrow-Band Measures of Depression

The Beck and Hamilton Depression Index

The Beck Depression Inventory is a 21-item scale designed to assess clinical depression. Respondents rate each item using a 4-point scale. Since all of the items are obvious, the scale is prone to a faked-bad response set. That means that it is easy for respondents to fake responses to appear depressed when, in fact, they are not depressed, and vice versa. The Hamilton Depression Scale contains primarily items dealing with more vegetative symptoms of depression (i.e., sleep, appetite, and energy). The instrument can be used to screen for the more severe forms of depression.

Measures of Mania

Mania refers to an abnormally elevated mood that is often accompanied by both excessive cheerfulness and irritability. During a manic episode there is a decreased need for sleep, increased energy, rapid thought processes, excessive grandiosity, and distractibility. Depending on the severity of the condition, delusional thinking may also be present. Mania differs from impulsivity in that there is a loss of self-control and a disturbance in emotions. Usually a period of deep depression follows the manic episode. This condition was known as manic depression but is now known as bipolar disorder.

Scale Ma From the MMPI-2

The Hypomania clinical scale contains 46 items with four major content areas: amorality, psychomotor acceleration, imperturbability, and ego inflation. The major theme underlying these items is impulsivity.

Scale N From the MCMI-III

The MCMI-III contains a 13-item Bipolar: Mania scale. Item content pertains to overactivity, elation and inflatedness, flight of ideas, variable moods, overtalkativeness, and impulsivity. Clinically elevated scores suggest a patient with labile emotions and frequent mood swings. During the manic phase, symptoms can include flight of ideas, pressured speech, overactivity, unrealistic and overexpansive goals, impulsive behavior, and a demanding quality in their interpersonal relationships.

The PAI Mania Scale

The PAI Mania scale (24 items) assesses both mania and hypomania (i.e., an abnormality of mood resembling mania but of lesser intensity). Content addresses elevated mood, irritability, impatience, expansiveness, grandiosity, and exaggerated activity. The scale has three subscales addressing Activity Level, Grandiosity, and Irritability.

Measures of Hostility

The Hostility Scale From the SCL-90-R

The SCL-90-R Hostility scale addresses such things as anger, aggression, rage, and resentment, and more attenuated feelings such as thoughts of anger.

Cook-Medley Hostility Scale From the MMPI-2

A hostility scale (Ho) based on the original item pool of the MMPI has been extensively researched as a predictor of health outcomes and the physiological mechanisms underlying the association between hostility and health. These emotions play a role in coronary artery disease and the Type A personality style.

Megargee’s Overcontrolled Hostility Scale

This scale, developed from the MMPI item pool, was designed to differentiate between two types of violent criminal. Undercontrolled offenders are the type of aggressive, angry, physically violent individuals most readily recognized as dangerous by individuals and society in general. In contrast, overcontrolled offenders are seen as passive. They inhibit their aggressive impulses and generally are highly constrained until they engage in a violent physical assault. Those who knew these individuals viewed them as nice, polite members of society and are often stunned when learning of their violent behavior. The MMPI items that differentiated the undercontrolled individual reveal a passive and nonaggressive personality. Hence, the scale is labeled “overcontrolled hostility.” The validity of this scale has been limited to an offender population.

Evaluation of Scales

All of the scales discussed in this article are psycho-metrically sound. They have acceptable internal consistency and test-retest reliabilities across a 1-week interval. Most of these scales are susceptible to faking because they contain obvious items dealing with the circumscribed mood. Some are embedded as scales in a large omnibus inventory. The effects of extracting these scales from their omnibus inventory and administering them separately are not yet well understood.

Some of these scales have a general mood scale that contains the major content components or dimensions of the mood, while others have subscales that assess specific components scale of these construct. The latter type of scale allows psychologists to check for differential endorsement of specific symptoms within a domain (e.g., endorsing cognitive but not physiological item). However, such differential endorsement is usually atypical.

These scales generally are quite adequate in doing what they are designed to do. There are very little differences between them that would warrant choosing one over the other. The choice of the scale depends on the needs of the psychologist, time considerations, the setting and context in which the assessment occurs, and the motivation of the client.

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