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 Emotion Thermometers Tool ©

    A rapid modular screening tool for detection and monitoring of emotional disorders in clinical practice

Background

In 1998 the Distress Thermometer (DT) was developed and validated for evaluation of distress (and anxiety and depression) in cancer [Roth et al, 1998]. It was adopted into recommendations by the US National Comprehensive Cancer Network. The DT is a simple, self-report, pencil and paper measure consisting of a line with a 0-10 scale anchored at the zero point with ‘No Distress’ and at scale point ten with ‘Extreme Distress’. Patients are given the instruction “How distressed have you been during the past week on a scale of 0 to 10?” The recommended cut-off was 4v5, but in 2007 was revised to 3v4. In a comprehensive review of the accuracy of the DT, it was found to have a sensitivity of 80.9% and a specificity of 60.2%, (positive predictive value (PPV) of 32.8 and negative predictive value (NPV) of 92.9%) for depression, a sensitivity of 77.3% and specificity 56.6% (PPV of 55.2% and NPV of 80.25%) for anxiety it and a sensitivity of 77.1% and specificity 66.1% (PPV 55.6% and NPV 84.0%) for broadly defined distress [Mitchell, 2007].

In 2007 we piloted and validated an extension of the DT called the Emotion Thermometers Tool. This is a new five dimensional tool retaining the convenience of the innovative DT but with superior accuracy. It comprises five visual analogue scales in the form of four predictor domains (distress, anxiety, depression, anger) and one outcome domain (need for help). Each domain is rated on an 11 point (0 to 10) Likert scale in a visual thermometer, namely the Distress Thermometer (DT), Depression Thermometer (DepT), Anxiety Thermometer (AnxT) and Anger Thermometer (AngT). In a pilot evaluation in the Leicester Cancer Centre (UK), we found that the tool takes about 45 seconds (compared to about 20 seconds for the DT) for most patients for complete and is no less acceptable than the DT alone.

ET Versions

The 2007 original version (ET5) comprised four emotion domains and a help thermometer

The 2009 ET7 added duration of illness and burden to the core thermometers above

We currently have pilot versions adding domains of function (work, social, family), pain, and QoL

We have pilot versions including descriptive text anchors for the thermometers of help and pain.

Tool Download (Original version)

Download PDF Original Version

Download Word Version (by request only)

Download JPG Original Version

Download PDF Version in checklist format

Download PDF Version in Spanish (thanks Angelica DeSantiago!)

Download PDF Version in Portuguese (thanks Margarid Branco!)

Download PDF Version in Dutch (thanks Joke Fleer!)

Download PDF Version in German (thanks Cord Spilker!)

Download PDF Version in French (thanks Sylvie Lambert!)

Validation Papers (full papers published in Psycho-oncology 2010 Feb;19(2):125-33 and 2010 Feb;19(2):134-140)

In our study in the Leicester Cancer Centre, 11.5% of people scored three or below on all ET domains and 69.3% scored four or above on at least one domain. Of low scorers on the DT about 50% recorded emotional difficulties on the new Emotion Thermometers (ET) tool, suggesting added value beyond the Distress thermometer (DT) alone. Using a cut-off of 3v4 on all thermometers against the total HADS score (cut-off 14v15), the optimal thermometer was the AngT (sensitivity 89% specificity 46%). Against HADS Anxiety scale (cut-off 7v8), and judging by the Predictive Summary Index, the optimal thermometer was AnxT (sensitivity 92% specificity 61%). Against the HADS depression scale, the optimal thermometer was the depression thermometer (sensitivity 60% specificity 78%). Finally, against the DSM-IV diagnosis of major depression the optimal thermometer was the depression thermometer sensitivity 80% specificity 79%) but no single method had good positive predictive value (PPV). Further improvements can be made by adjusting the cut-offs particularly for detection of anxiety (AnxT ROC = 0.867 at a cut-off of 5v6) and detection of depression (DepT ROC = 0.751 at a cut-off 4v5).

Validation Posters

We have published a series of posters on the ET at the IPOS and APOS conferences 2010-2012.

IPOS2010 Poster 130 (defining ET thresholds) | IPOS2010 Poster 131 (defining ET reliability) | IPOS2010 Poster 131 (ET re-validation) | APOS2011 Poster 153 (ET Re-validation vs depression)

Copyright

The tool is subject to copyright (c) Alex J Mitchell but freely available (royalty free) for non-commercial and clinical use.

If this (or related) tools are useful please consider donating to help with our research

Current Research on the ET

We welcome collaborations with other groups who are interested in using the ET for research. The following groups have sought permission to study the ET in various settings