Positive states of mind Scale (PSOM)

Abstract

The Positive States of Mind Scale (PSOM) is a brief, psychometrically validated self-report instrument developed by Mardi J. Horowitz and colleagues at the University of California, San Francisco (UCSF). Originally introduced in 1988 to counterbalance the prevailing clinical focus on psychopathology and psychological distress, the scale assesses an individual's capacity to achieve, maintain, and access functional, adaptive, and pleasurable cognitive and affective states despite ambient life stressors. The standard PSOM comprises seven core items measuring distinct states of psychological functioning: Focused Attention, Productivity, Responsible Caretaking, Restful Repose, Sharing, Sensuous Nonsexual Pleasure, and Dual Task-Focus (or Carefree Playfulness). Each item is evaluated on a 4-point rating scale ranging from 0 (Unable to experience / completely absent) to 3 (Experienced easily / fully present), yielding an aggregate total score from 0 to 21. Higher scores denote greater ease, frequency, and regulatory competence in entering positive states of mind. Psychometric evaluations across diverse non-clinical, medically ill, and psychiatric populations demonstrate acceptable to strong internal consistency (Cronbach's alpha coefficients typically ranging from .69 to .83), adequate test-retest reliability, and robust convergent and discriminant validity. Confirmatory factor analytic investigations generally support a unidimensional general factor of positive psychological capacity, with secondary structural models revealing agentic and hedonic-relational sub-components. The instrument is widely utilized in clinical psychology, psychosomatic medicine, stress response research, and strengths-based therapeutic evaluation.

Keywords

Positive States of Mind Scale, PSOM, Mardi Horowitz, Nancy Adler, positive psychology, psychological resilience, subjective well-being, psychometrics, stress response syndromes, mental health assessment

Authors

The Positive States of Mind Scale was primarily conceptualized and validated by investigators associated with the Program on Conscious and Unconscious Mental Processes and the Department of Psychiatry at the University of California, San Francisco (UCSF):

• Mardi J. Horowitz, M.D.: Professor of Psychiatry at the University of California, San Francisco School of Medicine. Dr. Horowitz is an internationally recognized psychoanalyst and clinical researcher noted for his foundational work on stress response syndromes, personality schema theory, and the development of the Impact of Event Scale (IES).
• Nancy E. Adler, Ph.D.: Professor of Medical Psychology in the Departments of Psychiatry and Pediatrics at the University of California, San Francisco, and Director of the Center for Health and Community. Dr. Adler is a pioneer in health psychology, social determinants of health, and the psychoneuroimmunology of subjective health perceptions.
• S. Stephen Kegeles, Ph.D.: Professor Emeritus of Medicine at the Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, specializing in behavioral medicine and public health research methodologies.
• Additional Psychometric Contributors: Subsequent validation and expansion studies were conducted by Nancy E. Adler, Mardi J. Horowitz, A. Garcia, and A. Moyer (1998) to establish normative parameters and structural integrity across diverse community and medical cohorts.

Purpose

For several decades, clinical psychiatry and assessment psychology operated under a disease-oriented paradigm dominated by the quantification of negative symptoms, distress, and psychological impairment. Diagnostic batteries systematically identified the presence of dysphoria, anxiety, intrusion, and avoidance, while failing to assess the patient's residual or premorbid capacities for well-being, concentration, and interpersonal warmth. The Positive States of Mind Scale was designed to address this psychometric imbalance by providing an empirical metric capable of evaluating psychological strengths, functional coping assets, and positive emotional states.

The primary clinical purpose of the PSOM is to evaluate the degree to which individuals are capable of transitioning out of defensive, distressed, or dysregulated states into restorative cognitive-affective modes. Horowitz's clinical formulations posited that healthy adaptation following severe life trauma, bereavement, or chronic medical illness is not merely marked by the reduction of intrusive distress, but crucially by the capacity to access functional and restorative states of mind. In therapeutic contexts, the PSOM serves as an outcome measure sensitive to psychotherapeutic progress, tracking the client's gradual reclamation of focus, intimacy, relaxation, and playful spontaneity.

In medical and behavioral research, the PSOM facilitates the investigation of mind-body pathways. Psychoneuroimmunology and psychosomatic medicine have linked sustained positive affective states to attenuated sympathetic-adrenal-medullary (SAM) activation, improved hypothalamic-pituitary-adrenal (HPA) axis regulation, and heightened immune competence. By assessing states such as Restful Repose and Sensuous Pleasure, the PSOM allows researchers to delineate the physiological buffers that mitigate physical illness and accelerate somatic recovery.

Psychological Construct

The psychological construct measured by the PSOM is the regulatory competence and subjective ease with which an individual achieves and sustains specific adaptive, non-pathological states of mind. Rather than assessing static personality traits, the instrument focuses on cognitive-affective experiential states that reflect intact ego functioning, emotional equilibrium, and cognitive control. The construct encompasses seven operationalized dimensions:

• Focused Attention: The subjective experience of directed cognitive concentration, task vigilance, and intentional focus in the absence of internal intrusive disruptions (such as intrusive memories, ruminations, or dissociative phenomena). This dimension reflects executive functioning and selective attentional gating.
• Productivity: The sense of instrumental agency, goal persistence, creative synthesis, and problem-solving effectiveness. It assesses the psychological capacity to sustain industrious engagement until task completion and generate novel responses to environmental challenges.
• Responsible Caretaking: The experience of self-efficacy and moral competence directed toward supportive action, whether attending to one's own somatic, psychological, or pragmatic needs, or extending care, altruism, and assistance to others.
• Restful Repose: A state characterized by neurovisceral deceleration, somatic relaxation, cognitive tranquility, and the absence of excessive motor tension or autonomic arousal. It operationalizes the psychophysiological capacity for recuperation.
• Sharing: The interpersonal capacity for relational intimacy, shared empathy, open dialogue, and social communion. It taps into secure attachment behavior, interpersonal warmth, and the non-defensive enjoyment of social connectedness.
• Sensuous Nonsexual Pleasure: The experiential appreciation of aesthetic, sensory, or intellectual stimuli. This includes somatic enjoyment (e.g., warm baths, culinary appreciation), intellectual immersion, engagement with nature, or aesthetic appreciation of art, free from guilt or inhibition.
• Dual Task-Focus / Carefree Playfulness: The ability to maintain cognitive flexibility, effortlessly switch between tasks, or engage in spontaneous, lighthearted, and recreational play. It represents the psychological capacity for levity, humor, and cognitive elasticity without rigid constriction.

Theoretical Framework

The conceptual architecture of the Positive States of Mind Scale is grounded in Horowitz's Cognitive-Dynamic Theory of Personality and States of Mind (Horowitz, 1987, 1991). Within this theoretical model, the human psyche is conceptualized not as a monolithic, static entity, but as a dynamic system that shifts among distinct states of mind. A state of mind represents a discrete, organized pattern of conscious experience, cognitive processing, somatic tension, nonverbal expression, and emotional tone.

Horowitz proposed that psychopathology—most notably observed in stress response syndromes and borderline or narcissistic personality organizations—is characterized by recurrent, unbidden, and poorly regulated negative states (e.g., states of dread, helpless rage, intrusive terror, or frozen numbness). Conversely, psychological maturity and resilience are manifested in the presence of flexible regulatory mechanisms (termed control schemas) that allow the person to actively suppress or transcend intrusive distress and initiate restorative, positive states of mind.

This framework parallels contemporary models in positive psychology, such as Barbara Fredrickson's Broaden-and-Build Theory, which posits that positive emotions broaden an individual's momentary thought-action repertoire and build enduring personal resources. Furthermore, the PSOM intersects with Aaron Antonovsky's salutogenic paradigm, emphasizing internal resources that promote health and coherence rather than solely analyzing risk factors for illness.

Validity

The psychometric validity of the PSOM has been rigorously established across several decades of empirical study:

• Construct Validity: In the original validation studies by Horowitz, Adler, and Kegeles (1988), non-clinical control groups scored substantially higher across all PSOM dimensions compared to psychiatric outpatients and bereavement-seeking cohorts. Individuals who were actively experiencing pathological grief or post-traumatic intrusion exhibited marked deficits in reaching states of Restful Repose, Focused Attention, and Sensuous Pleasure.
• Convergent Validity: The PSOM demonstrates statistically significant positive correlations with established measures of dispositional optimism (Life Orientation Test, r = .45 to .58), subjective well-being, and the Positive Affect scale of the Positive and Negative Affect Schedule (PANAS, r = .52 to .64). Conversely, it correlates inversely with measures of depressive symptom severity, such as the Beck Depression Inventory (BDI) (r = -.48 to -.62), and psychological distress scales like the General Health Questionnaire (GHQ).
• Discriminant Validity: Research by Adler et al. (1998) demonstrated that the PSOM measures a construct distinct from mere absence of negative affect. In structural equation modeling (SEM), models evaluating positive states of mind and negative emotional distress as separate, oblique factors exhibited superior fit compared to single-factor models, confirming that the capacity for positive states is not simply the inverse of emotional distress.
• Predictive and Clinical Validity: In longitudinal studies examining psychological adjustment after traumatic life events or serious medical diagnoses (such as cancer or cardiovascular surgery), baseline PSOM scores predict long-term psychological recovery, functional independence, and lower incidence of post-treatment depression, even after controlling for baseline illness severity.

Reliability

The Positive States of Mind Scale demonstrates sound reliability across diverse research and clinical contexts:

• Internal Consistency: In the initial psychometric report by Horowitz et al. (1988), Cronbach's alpha for the 7-item scale was reported at .69 for a clinical population and .73 for non-clinical samples. In the comprehensive re-evaluation by Adler, Horowitz, Garcia, and Moyer (1998), internal consistency was estimated between .80 and .83 across diverse undergraduate, working adult, and medically ill cohorts. These values demonstrate high internal cohesion without excessive item redundancy.
• Test-Retest Reliability: Over short test-retest intervals (1 to 2 weeks), stability coefficients remain moderate to high (Pearson's r ranging from .70 to .81), indicating stable measurement of current state capacity. Over longer intervals (3 to 6 months), test-retest correlations moderately attenuate (r = .45 to .55), which aligns with theoretical expectations that the PSOM functions as a state-capacity metric sensitive to therapeutic interventions, personal growth, and shifting life stressors.
• Split-Half Reliability: Guttman split-half and Spearman-Brown reliability coefficients across independent cohorts consistently surpass .74, reinforcing the balance of the 7-item composition.

Factor Analysis

Extensive factor analytic investigations have explored the latent dimensional structure of the PSOM:

• Exploratory Factor Analysis (EFA): Principal component and principal axis factoring analyses conducted across community and clinical samples (Adler et al., 1998) routinely yield a dominant first factor accounting for approximately 42% to 54% of the total variance, supporting the computation of a composite aggregate score. Factor loadings for individual items onto this primary general factor are robust: Focused Attention (.62 to .71), Productivity (.65 to .75), Responsible Caretaking (.48 to .60), Restful Repose (.58 to .69), Sharing (.55 to .68), Sensuous Pleasure (.60 to .72), and Playfulness/Dual-Task Focus (.52 to .64).
• Confirmatory Factor Analysis (CFA): Two primary structural models have been evaluated in the literature: a unidimensional model and an oblique two-factor model distinguishing between Agentic / Instrumental States (Focused Attention, Productivity, Responsible Caretaking) and Hedonic / Relational States (Restful Repose, Sharing, Sensuous Pleasure, Playfulness). CFA investigations demonstrate acceptable to good fit for the single-factor model (Comparative Fit Index [CFI] = .94 to .96; Root Mean Square Error of Approximation [RMSEA] = .048 to .062; Standardized Root Mean Square Residual [SRMR] = .038 to .049). While the two-factor model occasionally demonstrates marginal statistical superiority, the high correlation between factors (r > .70) justifies using the unidimensional total score in clinical research and practice.

Instrument / Measurement Tool

• Test Type: Brief, standardized self-report rating scale.
• Administration Format: Paper-and-pencil questionnaire or computerized/interactive digital inventory.
• Target Population: Adolescents (ages 14+) and adults across general, medical, and psychiatric populations.
• Number of Items: 7 core experiential items.
• Administration Time: Approximately 2 to 5 minutes.
• Response Format: 4-point ordinal rating scale: 0 = Unable to experience / completely absent, 1 = Experienced with great difficulty / barely present, 2 = Experienced with some difficulty / moderately present, 3 = Experienced easily / fully present.
• Scoring Procedure: All items are phrased positively. Individual item scores (0 to 3) are summed directly to generate a total scale score ranging from 0 to 21. No reverse scoring is required.
• Score Interpretation:
  • 0–7 (Low Positive State Capacity): Suggests severe difficulty in accessing restorative, productive, or relaxed mental states; commonly observed in severe depression, active PTSD, or decompensated burnout.
  • 8–14 (Moderate Positive State Capacity): Reflects intermittent or effortful access to positive states; common in individuals experiencing moderate situational life stress or partial therapeutic recovery.
  • 15–21 (High Positive State Capacity): Denotes robust psychological flexibility, strong executive attention, easy access to intimacy, somatic relaxation, and emotional resilience.

Permissions & Fee and Test Year

The Positive States of Mind Scale was initially introduced by Mardi J. Horowitz, Nancy E. Adler, and S. Stephen Kegeles in 1988, with expanded psychometric validation published by Adler, Horowitz, Garcia, and Moyer in 1998. The scale is widely accessible in the scientific literature and is placed within the public domain for academic, non-commercial clinical, and empirical research purposes without royalty or licensing fees. Researchers and clinicians may administer the instrument freely, provided that standard academic attribution and citation are given to the original authors and published validation studies. Commercial software distribution, test battery incorporation for sale, or proprietary licensing requires formal permission from the copyright holders or publishing journals.

References

• Adler, N. E., Horowitz, M. J., Garcia, A., & Moyer, A. (1998). Additional validation of a scale to assess positive states of mind. Psychosomatic Medicine, 60(1), 26–32. https://doi.org/10.1097/00006842-199801000-00006
• Horowitz, M. J. (1987). States of mind: Configurational analysis of individual psychology (2nd ed.). Plenum Press. https://doi.org/10.1007/978-1-4757-0480-8
• Horowitz, M. J., Adler, N., & Kegeles, S. (1988). A scale for measuring the occurrence of positive states of mind: A preliminary report. Psychosomatic Medicine, 50(5), 477–483. https://doi.org/10.1097/00006842-198809000-00004
• Horowitz, M. J. (1991). Person schemas and maladaptive interpersonal patterns. The University of Chicago Press.
• Simmons, C. A., & Lehmann, P. (Eds.). (2013). Tools for strengths-based assessment and evaluation. Springer Publishing Company. https://doi.org/10.1891/9780826195777

Items of the Scale