State-Trait Anxiety Inventory (STAI)

• DATE: 1970 forward
• TYPE OF PSYCHOLOGY: Personality; psychopathology

The State-Trait Anxiety Inventory, developed in 1970, was among the most widely used questionnaires to measure anxiety in the twenty-first century. The brief forty-item inventory is widely used in clinical and research settings.

Introduction

The State-Trait Anxiety Inventory (STAI) is a very widely used measure of anxiety. It was developed by American psychologist Charles Spielberger, who first published it in collaboration with Richard L. Gorsuch, Robert Lushene, Peter R. Vagg, and Gerald A. Jacobs in 1970. It is copyrighted by Consulting Psychologists Press.

The State-Trait Anxiety Inventory consists of forty items about a person’s feelings of anxiousness that are divided into two subscales of twenty items each for state and trait anxiety. Respondents rate their feelings on a four-point scale ranging from 1 ("Almost Never") to 4 ("Almost Always"). Some of the items are worded positively (“I feel calm”); others are worded negatively (“I am tense”). The positive items are reverse-scored, so that higher scores indicate more anxiety. In the state form (also called Y-1), the items are about the respondent’s feelings at a particular moment in time; in the trait form (also called Y-2), the items are about the respondent’s general feelings overall. The STAI has cut-off scores; a score over this point indicates clinically relevant anxiety symptoms. Form Y is the second revision of the STAI, developed in 1983; the first was called Form X.

The STAI has several versions tailored for various populations. Test forms include a children’s version (the State-Trait Anxiety Inventory for Children, or STAIC) which uses language appropriate for younger respondents; a short version with only six items; and a version for parents to complete about their children. There are versions in many different languages, including Arabic, Amharic, Chinese, Czech, Dutch, French, German, Hindi, Italian, Japanese, Norwegian, Polish, Portuguese, Spanish, and Thai.

Uses

The STAI has clinical uses: It can be administered before and after therapy, or before and after medication for anxiety disorders. For example, in one report, a woman had a distressing vocal tic, which meant that she involuntarily made repeated sounds and words and coughed. A vocal tic is similar to stuttering. She received therapy that included awareness training, a review of situations and of how inconvenient the habit was, relaxation training, the learning of competing responses, and social support. The therapist measured whether she improved by videotaping her and counting the number of vocal tics and having her complete the STAI to measure her anxiety. She improved in having fewer vocal tics and less anxiety.

The STAI is widely used in research with both adults and children. In a citation analysis of six commonly used measures of anxiety, it ranked first. It is so widely used because it is a reliable and valid research instrument. One type of reliability is test-retest reliability, which means that people typically describe themselves the same way on the STAI from one time to another. Another type of reliability is internal consistency, which means that all the STAI questions are measuring the same thing. In terms of validity, the STAI is correlated with other measures of anxiety. Also, people who describe themselves as anxious or who are diagnosed with anxiety disorders score higher on the STAI than people who describe themselves as calm or who are not diagnosed with anxiety disorders. For research purposes, questionnaires must be reliable and valid to be useful, and the STAI meets both criteria.

An example of a research project using the STAI with adults was a study of 147 cancer patients (mean age 57.6 years). They completed the STAI and interviews before and after discussions with their cancer physician. Patients who did not like their physician’s communication style had higher anxiety following the discussion. Further, after the discussion, patients’ anxiety levels remained low, even among those patients with unfavorable examination results, when the patients liked their physician’s communication style.

An example of a research project using the STAI with children is a study of ninety children with spina bifida who attended a one-week summer camp. They completed the STAI before and after camp. By the end of the camp, their anxiety was lower than it had been at the beginning.

Bibliography

Antony, Martin M., and Murray B. Stein, editors. Oxford Handbook of Anxiety and Related Disorders. Oxford UP, 2009.

Briery, Brandon G., and Brian Rabian. “Psychosocial Changes Associated with Participation in a Pediatric Summer Camp.” Journal of Pediatric Psychology, vol. 24, no. 2, 1999, pp. 183–190.

Carducci, Bernardo J. The Psychology of Personality: Viewpoints, Research, and Applications. Wiley, 2009.

Fuata, Patricia, and Rosalyn A. Griffiths. “Cognitive Behavioural Treatment of a Vocal Tic.” Behavior Change, vol. 9, no. 1, 1992, pp. 14–18.

Groth-Marnat, Gary. Handbook of Psychological Assessment. 5th ed., Wiley, 2009.

McDowell, Ian. Measuring Health: A Guide to Rating Scales and Questionnaires. 3rd ed., Oxford UP, 2006.

"The State-Trait Anxiety Inventory (STAI)." American Psychological Association, www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/trait-state. Accessed 3 Dec. 2024.

Stein, Dan J., Eric Hollander, and Barbara Olasov Rothbaum. Textbook of Anxiety Disorders. 2nd ed., American Psychiatric, 2010.

Takayama, Tomoko, Yoshihiko Yamazaki, and Noriyuki Katsumata. “Relationship Between Outpatients’ Perceptions of Physicians’ Communication Styles and Patients’ Anxiety Levels in a Japanese Oncology Setting.” Social Science and Medicine, vol. 53, no. 10, 2001, pp. 1335–50.