Skip to main content
Article thumbnail
Location of Repository

The STRS (shortness of breath, tremulousness, racing heart, and sweating): A brief checklist for acute distress with panic-like autonomic indicators; development and factor structure

By H. Stefan Bracha, Andrew E. Williams, Stephen N. Haynes, Edward S Kubany, Tyler C. Ralston and Jennifer M. Yamashita


Background: Peritraumatic response, as currently assessed by Posttraumatic Stress Disorder (PTSD) diagnostic criterion A2, has weak positive predictive value (PPV) with respect to PTSD diagnosis. Research suggests that indicators of peritraumatic autonomic activation may supplement the PPV of PTSD criterion A2. We describe the development and factor structure of the STRS (Shortness of Breath, Tremulousness, Racing Heart, and Sweating), a one page, two-minute checklist with a five-point Likert-type response format based on a previously unpublished scale. It is the first validated self-report measure of peritraumatic activation of the autonomic nervous system.\ud \ud Methods: We selected items from the Potential Stressful Events Interview (PSEI) to represent two latent variables: 1) PTSD diagnostic criterion A, and 2) acute autonomic activation. Participants (a convenience sample of 162 non-treatment seeking young adults) rated the most distressing incident of their lives on these items. We examined the factor structure of the STRS in this sample using factor and cluster analysis.\ud \ud Results: Results confirmed a two-factor model. The factors together accounted for 68% of the variance. The variance in each item accounted for by the two factors together ranged from 41% to 74%. The item loadings on the two factors mapped precisely onto the two proposed latent variables.\ud \ud Conclusion: The factor structure of the STRS is robust and interpretable. Autonomic activation signs tapped by the STRS constitute a dimension of the acute autonomic activation in response to stress that is distinct from the current PTSD criterion A2. Since the PTSD diagnostic criteria are likely to change in the DSM-V, further research is warranted to determine whether signs of peritraumatic autonomic activation such as those measured by this two-minute scale add to the positive predictive power of the current PTSD criterion A2. Additionally, future research is warranted to explore whether the four automatic activation items of the STRS can be useful as the basis for a possible PTSD criterion A3 in the DSM-V

Topics: Behavioral Analysis, Psychobiology, Psychophysiology, Neurophysiology, Physiological Psychology, Clinical Psychology, Evolutionary Psychology
Year: 2004
OAI identifier:

Suggested articles


  1. (2000). Acute stress disorder scale: a self-report measure of acute stress disorder. Psychological Assessment
  2. (2002). Acute stress disorder: a synthesis and critique. Psychological Bulletin
  3. (2004). Adaptationist perspective on the acute stress response spectrum.
  4. (2000). Association: Diagnostic and statistical manual of mental disorders. Fourth Edition, Text Revision.
  5. (2004). Can premorbid episodes of diminished vagal tone be detected via histological markers in patients with PTSD?
  6. (1995). Cardiac vagal tone: a physiological index of stress. Neuroscience and Biobehavioral Reviews
  7. Clinical research histomarkers for objectively estimating premorbid vagal tone chronology in gulf war veterans' illnesses and in acute stress reaction. In: Formal descriptions of developing systems
  8. (2003). Early predictors of posttraumatic stress disorder. Biological Psychiatry
  9. (2003). Fright (effroi) and other peritraumatic responses after a serious motor vehicle accident: prospective influence on acute PTSD development.
  10. (2000). helplessness, and horror in posttraumatic stress disorder: investigating DSM-IV criterion A2 in victims of violent crime.
  11. (2003). JL: Trauma in the lives of older men: findings from the normative aging study.
  12. (2000). ML: A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder.
  13. (1999). MR: Review and critique of the new DSM-IV diagnosis of acute stress disorder.
  14. (2002). Orr SP: Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biological Psychiatry
  15. (2003). Peritraumatic and persistent panic attacks in acute stress disorder. Behav Res Ther
  16. (2003). Prediction of the occurrence and intensity of post-traumatic stress disorder in victims 32 months after bomb attack. Eur Psychiatry
  17. (1999). Predictors of acute stress following motor vehicle accidents.
  18. (1997). Sahar T: Predicting PTSD in trauma survivors: prospective evaluation of selfreport and clinician-administered instruments.
  19. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system.
  20. (1997). Treatment failure in acute PTSD: lessons learned about the complexity of the disorder.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.