Integral Stress Test™ (IST™-Test)

This test method is a holistic and scientifically proven instrument to detect systemic causes of exhaustion and fatigue. The test is composed of individual modules, which can be used separately. In order to detect individual risks related to consequences of stress and mental illness, the entire standardized integral stress test™ should be performed. All data is collected by the participants themselves. This includes saliva and urine samples, answering electronic questionnaires, as well as an HRV measurement (heart rate variability).


The time required for this measurement is minimal and the results are immediately available to the support team in the form of precise reports. In the test, the various typical symptoms of stress (phenotypes), whose previous duration and subjective perception, the personal, family and professional stressors, and individual stress amplifiers (overwork, lack of boundaries, fear or anxiety, high self-expectations, perfectionism and gratification crisis) are recorded and qualitatively ranked. The questionnaires were designed with regard to psychological behavioral measures. All questionnaires can be answered in both traditional pen and paper form, and electronically via the latest internet interfaces, with failsafe transmission encryption. The questionnaires (symptoms of stress, stressors, and stress amplifiers, the Patient Health Questionnaire (PHQ), the Copenhagen Burnout Inventory Effort-reward Imbalance Questionnaire) are all made available in an IT environment developed by YourPrevention™. These can be filled in electronically by partcipants, even on mobile devices such as an iPad. The time required is 10 - 15 minutes.

Excerpt from the evaluation of neuropsychological tests questionnaire. The results show the stressors and their assignment to professional, family and personal stressors, stress amplifiers, with a presumptive diagnosis of mental disorders according to ICD-10 on the basis of the responses in the PHQ and the outcome of the Copenhagen Burnout Inventory (CBI).


The samples of saliva and urine provided by the participant are an objective assessment of the degree of exhaustion and performance. This neurobiological approach also allows better identification of the relationship between behavior and stress-strain, and thereby the development of targeted solutions. The measured markers are as follows:

Diurnal cortisol profile (in saliva)
The monitoring of salivary cortisol 30 minutes after waking up, 8:00 a.m, 2:00 p.m. and 8:00 p.m. defines regular adrenal performance, such as total activity throughout the observation period by determining the area under the curve (AUC), evidence of diurnality, maintenance of biorhythmical variation, and nonlinearity of the sequence of values.

Typical progressions of cortisol diurnal profile in the saliva at different diagnoses, but with large overlaps. Where there is reduced cortisol (= Hypocortisolism) there is often a post-traumatic stress disorder (PTSD) in the anamnesis, and a marked depletion of adrenal function is acutely recognizable. Excessive levels of cortisol (hypercortisolism) are found in 30-50% of cases of major depression. Inverted cortisol values reflect a significant disruption of the biochronology.

Neurotransmitters (the second urination of the morning)
In the second urination of the morning, on the one hand the neurotransmitters of the sympatho-excitatory stress response, such as norepinephrine, dopamine and glutamate, and the inhibitory neurotransmitter serotonin, and GABA (gamma aminobutyric acid), are determined by HPLC and fluorescence chemical presentation. This allows quantification of both the central nervous stress response of excitatory neurotransmitters and the inhibitory "stress brake" and their balance. As in the literature the serotonin-regulation is viewed particularly critically, from a clinical perspective, these parameters have become more crucial. Numerous authors work successfully with this diagnostic system. An excess of excitatory NT´s are just as significant as a deficit of inhibitors for a possible substitutive therapy.


Heart rate variability is a modern method for documenting the sympathetic and parasympathetic (vagus nerve) related influences on cardiac pulse variability over 24-72 hours. With the help of modern data processing systems, the resulting raw data are filtered by their variability (HF = high frequency, LF = low frequency) analyzed, characterized, and clinically usable parameters are calculated and displayed both numerically and graphically. Important clinical insightful parameters are:

  • pulse rate Determined
  • LF (low frequency) = sympathetic (low vagal)
  • HF (high frequency) = predominantly vagal determined
  • HF / LF - ratio • pNN50 =% of heartbeats, with > 50 milliseconds intervals, and
  • RMSSD = square root of the squared standard deviations of the mean values as the most significant indicator of vagal activity

Using this FirstBeat testing method, three consecutive days and nights are recorded to better recognize diurnal fluctuations and to obtain a more representative result. The HRV is provides an indication of how well the individual is able to recover, and how lifestyle (sports, private and professional environment, alcohol consumption, etc.) affects the recovery. This measurement is also suitable for the measurement of the progress and objective evaluation of recovery in sleep, an essential component in the production of resources.

Graphical representation of a 3-day monitoring of heart rate variability. The recovery in a very good area on the 2nd night highlights the significant losses in recovery on the other two nights through evening sports (overtraining) and alcohol consumption. The measurement and analysis of HRV is done with the BodyGuard2 by First Beat. Via two adhesive electrodes, the RR of the ECG signal is tapped, and thus enables the precise detection of pulse and heart rate variability in milliseconds. The aim of this method is above all to record regenerating vagal activity during the day and at night, to quantify it, in order to check and document recovery and regeneration capacity, particularly at night.


The HRV and laboratory tests are diagnosed by us individually. We will give you an individual report with a clear recommendation for further treatment or diagnosis if necessary. If you are interested in taking the Integral Stress Test™, please contact us directly. The cost per test and a detailed consultation is approximately EUR 500.

If you are interested in taking an IST™TEST, just make an appointment with us.

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