> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # PSS-10 — Perceived Stress Scale > Ten-item measure of how unpredictable, uncontrollable, and overloaded a client feels — the standard tool for burnout and stress-management work. The PSS-10 measures *perceived* stress — the subjective appraisal of whether life feels unpredictable, uncontrollable, and overloaded — over the past month. It deliberately doesn't ask how many stressors a client has or what they are. Two clients with identical event-counts can have very different PSS-10 scores, and the score-not-the-events is what predicts health and functional outcomes. If you do stress-management work — MBSR, CBT for stress, problem-solving therapy, burnout coaching — this is the workhorse outcome measure. ## What it measures Subjective appraisal of stress along three dimensions: * **Unpredictability** — feeling things happen without warning. * **Uncontrollability** — feeling unable to control important things in life. * **Overload** — feeling unable to cope with the volume of demands. Half the items are negatively phrased (felt stressed, couldn't cope) and half are positively phrased (felt confident, felt on top of things). The positive items are reverse-scored. ## When to use it * **Intake for burnout, adjustment, or stress-load presentations** — a baseline before treatment starts. * **Every 4 weeks during stress-management interventions** to track change. * **Pre/post a structured protocol** (MBSR 8-week, time-management course, workplace intervention). * **As an outcome measure** rather than a state measure — the 30-day look-back makes it less responsive to recent events than the K10 with its same window. ## How clients fill it out Ten items rated 0-4 (Never → Very often) over the past month. Three to five minutes. Reading level grade 6. ## Scoring and severity cutoffs Sum of all ten items, range 0-40. Items 4, 5, 7, and 8 — the positive-coping items ("felt confident", "felt things were going your way", "been able to control irritations", "felt on top of things") — are reverse-scored. Rivet handles the reversal automatically; the score you see on screen and in the session note is already correct. ### Bands | Total | Band | | ----- | --------------- | | 0-13 | Low stress | | 14-26 | Moderate stress | | 27-40 | High stress | Bands are derived from Cohen's normative data and commonly cited in clinical practice. They're a useful frame for treatment planning, not a diagnostic threshold. ## Clinical change The PSS-10 is responsive to stress-management interventions. A 4-7 point drop across a treatment course is in the range of effects reported in MBSR and CBT-for-stress trials. A band shift (e.g. high → moderate) is the more robust signal for clinical documentation. ## PSS-10 vs DASS-21 and K10 All three get reached for when "stress" is the presenting word, and they measure three different things. * **PSS-10** measures appraisal — how unpredictable, uncontrollable and overloading the last month felt. Two people with identical circumstances can score far apart, which is the point. * **[DASS-21](/clinical-templates/screening/dass-21)** measures stress as a symptom state — tension, agitation, being easily upset — alongside depression and anxiety on separate subscales. * **[K10](/clinical-templates/screening/k10)** measures general psychological distress without attributing it to anything. For stress-management work — mindfulness-based programs, problem-solving therapy, CBT for stress — the PSS-10 is usually the outcome measure, because appraisal is what those approaches are trying to change. On burnout specifically: the Maslach Burnout Inventory is the standard instrument and it is licensed by Mind Garden for paid use. Rivet doesn't include it. The PSS-10 is the closest measure here, and it is measuring perceived stress, not burnout — worth saying plainly if the score is going anywhere formal. ## Is it free to use? **Yes, for non-commercial clinical use.** Cohen's lab at Carnegie Mellon distributes it as public-domain for non-commercial clinical use. There is no fee and no permission to request. ## Citation Cohen, S., Kamarck, T., & Mermelstein, R. (1983). "A global measure of perceived stress." *Journal of Health and Social Behavior,* 24(4): 385-396. Ten-item revision: Cohen, S., & Williamson, G. (1988). "Perceived stress in a probability sample of the United States." In S. Spacapan & S. Oskamp (Eds.), *The Social Psychology of Health: Claremont Symposium on Applied Social Psychology.* Public-domain instrument. Verbatim canonical wording per Carnegie Mellon (Cohen's lab) distribution. ## When not to use it * **You need to know what the stressors are.** PSS-10 doesn't characterize them — pair with an event-count instrument or clinical interview. * **Your frame is depression, anxiety, or PTSD.** Use the measure for that frame. * **You want a Canadian-standard general distress screen.** Use the K10. ## Related articles The Canadian general distress screener — broader than perceived stress. Three subscales when stress sits alongside depression or anxiety. How a template flows from picker to session note.