Emotional Functioning Instruments

1. Brief Screeners: Clinical Surface

PHQ-9 — Patient Health Questionnaire

The PHQ-9 (Kroenke, Spitzer & Williams, 2001) is a 9-item self-report screener directly mapping to the DSM diagnostic criteria for Major Depressive Episode. Each item rates frequency over the past two weeks on a 0–3 scale (not at all to nearly every day). Total scores: 0–4 minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe. The PHQ-9 has excellent sensitivity (.88) and specificity (.88) against structured clinical interview at a cutoff of ≥10.

The PHQ-9 measures the symptomatic surface of emotional functioning: current severity of depressive symptoms. It does not measure trait emotionality, defensive structure, or the ego’s relationship to affect — those require additional instruments.

GAD-7 — Generalized Anxiety Disorder Scale

The GAD-7 (Spitzer et al., 2006) is a 7-item screener for generalized anxiety symptom severity, mirroring the PHQ-9 format. Total scores: 0–4 minimal, 5–9 mild, 10–14 moderate, ≥15 severe. Validated against structured diagnostic interview with sensitivity .89 and specificity .82 at cutoff ≥10. The GAD-7 also performs reasonably well as a screen for panic disorder, social anxiety disorder, and PTSD.

Together, the PHQ-9 and GAD-7 provide rapid validated snapshots of symptomatic severity at the clinical surface level. They answer the question: “How symptomatic is this person right now?” They do not answer: “What is the functional substrate of these symptoms?”

2. Affect-Balance Context — PANAS

The PANAS (Watson, Clark & Tellegen, 1988) assesses two orthogonal dimensions of affect: Positive Affect (PA) and Negative Affect (NA). High PA = energized, enthusiastic, active. Low PA = flat, sluggish, withdrawn. High NA = distressed, hostile, fearful. Low NA = calm, at rest.

The two-factor structure was one of the most important discoveries in affective science: PA and NA are largely independent, not opposite ends of a single dimension. This means that reducing negative affect does not automatically increase positive affect — a clinically critical point for treatment planning. A patient whose depression remits on the PHQ-9 may still have persistently low PA (anhedonia, flat affect) requiring separate intervention.

PANAS can be administered with different time instructions: right now, today, this week, this year, in general. The “in general” instructions index trait affective disposition; momentary instructions capture state.

3. How the Instruments Work Together

The three-instrument stack — PHQ-9 + GAD-7 + PANAS — provides layered coverage:

• PHQ-9: Current depressive symptom severity; DSM criterion-mapped
• GAD-7: Current anxiety symptom severity; sensitive to multiple anxiety presentations
• PANAS: Trait dispositional affective style; PA and NA dimensions independently

A full emotional functioning assessment interprets these in relation to each other: elevated PHQ-9 with low PANAS-PA and normal PANAS-NA suggests anhedonic depression. Elevated GAD-7 with high PANAS-NA suggests a high-NA temperamental substrate that may be maintaining anxiety. The combination tells a more complete story than any single instrument.