How we measure program impact

Before and after our 3 to 6 months executive human performance programs, we apply the Sapiens Stress Diagnostics Kit to measure program impact.

The diagnostics kit has been developed together with Professor Dr. Clemens Kirschbaum who brings 40+ years in biopsychology and is an expert in stress diagnostics.

Our diagnostic employs a multi-modal approach, leveraging over 13 biomarkers and 5 scientifically validated self-assessments. This process generates more than 250 data points, providing a detailed and nuanced picture of stress and its effects on your body and mind.

We are currently working on a scientific publication with pre-/post data of large programs. Until that study with control for confounding variables, we are providing an initial overview of typical results of selected clients in the below review of impact areas.

Biomarkers used for measuring program impact

Hair Analysis: Provides a biological view of chronic stress and resilience factors with a three-month retrospective perspective. This includes measuring Cortisol, Cortisone, DHEA, Testosterone, and Endocannabinoids to give a comprehensive picture of stress over time.

ECG Monitor: Offers highly accurate HRV (Heart Rate Variability) analysis over the course of a workweek, far surpassing the precision of traditional wearable devices. This allows for minute-by-minute tracking of stress levels, seamlessly integrated with your calendar and daily activities for contextual insights.

Saliva Analysis: Delivers insights into daily hormonal patterns, such as your ability to ramp up energy levels after waking and wind down in the evening. This is achieved through multi-day, multi-time-point measurements of saliva cortisol and in some situations DHEA levels.

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Self-assessments used for measuring program impact

Perceived Stress Score: Measures your subjective experience of stress and its impact on your life.

Perceived Fatigue Scale: Identify markers of fatigue and exhaustion.

Brief Resilience Scale and Brief Resilience Coping Scale: Assess your ability to recover from stress and cope with challenges effectively.

Energy Leak Assessment: Evaluates symptoms related to 15 common “energy leaks,” such as metabolic health, dehydration, micronutrient deficiencies, and lifestyle fragmentation.

Resilience Habits Assessment: Examines key habits influencing resilience, including sleep, nutrition, fitness, social connections, and mindset.

Depending on the results of the above scales, we also offer deep-dive scales like the Burnout Assessment Tool, the AVEM scale to identify workstyles that are correlated with burnout, as well as anxiety and depression scales.

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Typical program impact

Using biomarkers and self-assessment tools, we have carefully tracked and measured the outcomes of our program, focusing on chronic stress, resilience, and overall energy levels.

Chronic Stress Reduction

Participants experienced a substantial reduction in chronic stress, with biological stress markers decreasing typically by 22% (full study to be published, that’s why we are only providing these preliminary data for now).

To measure this, we analyzed 3cm hair samples (Cortisone, Cortisol, and DHEA) from 16 clients over periods ranging from 5 to 8 months. Hair steroid analysis offers a retrospective view of approximately three months of stress levels, as hair grows around 1 cm per month. The labortory analysis was conducted by Dresden Lab Service GmbH under the supervision of Professor Dr. Clemens Kirschbaum.

We observed significant variations among individual clients; those initially presenting high stress levels showed the most notable improvements, whereas individuals with already moderate or lower levels showed minimal changes. While excessively low cortisol levels can potentially contribute to increased fatigue, the majority of our clients started with elevated cortisol, making reductions largely beneficial.

Additionally, perceived stress levels also improved significantly, with an average reduction of 23%. To evaluate this, we used the scientifically validated Perceived Stress Scale (PSS-4, see reference here), which involves participants rating their perceived stress on a 5-point scale before and after the program. On average, this translated to about a one-point improvement per question, reflecting a meaningful decrease in the perception of chronic stress.

Hair Cortisol Analysis has been validated by scientific studies and is commonly used in stress research settings.

• Pilot study of adrenal steroid hormones in hair as an indicator of chronic mental and physical stress: Kirschbaum et al., 2016
• Hair Measurements of Cortisol, DHEA, and DHEA to Cortisol Ratio as Biomarkers of Chronic Stress among People Living with HIV in China: Known-Group Validation: Qiao et al., 2017
• Hair cortisol and self-reported stress in healthy, working adults: Gidlow et al., 2015
• Detection of cortisone levels in human hair seems validated: Raul et al., 2004
• Analysis of cortisol in hair - state of the art and future directions: Kirschbaum & Stadler, 2012

Resilience

Our clients typically demonstrate an increase in a composite score of resilience factors of 20%.

As resilience is context-dependent and difficult to assess in one marker, we are measuring selected biological and psychological resilience factors. While this approach does not cover all aspects of resilience it is one of the most comprehensive resilience factor measurements in the market.

The 4 resilience factors that were measured are:

• Hair Steroid & Endocannabinoid Analysis
  • Endocannabinoids in 3 cm hair
  • DHEA/Cortisone ratio in 3cm hair
• ECG Monitoring
  • HRV Analysis for 5 workdays
• Self-assessed resilience
  • Brief Resilience Scale (2 selected items)

Hair DHEA/Cortisone Ratio

‍We particularly focused on the DHEA/Cortisone. DHEA is a critical hormone that balances stress responses, supports mood, protects brain function, and enhances vitality, thereby strengthening resilience. High-quality scientific studies, including Dutheil et al. (2021) and Yan Hu et al. (2000), confirm the importance of adequate DHEA levels in buffering stress-related negative impacts like anxiety and depression. We used Cortisone for this marker instead of a potentially more obvious choice, cortisol as cortisone is less prone to contamination by external products (like steroid containing cremes). Further studies indicating the stress buffering effects of DHEA:

• Lower levels of DHEA-S are associated with higher serum cortisol levels (Osei et al., 2022)
• DHEA administration reversed stress-induced inhibition in body weight gain, adrenal weight, glucocorticoid receptor levels, and lipid peroxidation in rats (Yan Hu et al., 2000)
• DHEA treatment resulted in higher salivary concentrations of DHEA and DHEAS and enhanced anabolic balance throughout sustained military stress (Taylor et al., 2012)
• The Cortisol/DHEA-S ratio, is related to mood disturbance and perceived stress (Cruess et al., 1999)

Hair Endocannbinoids

‍Similarly, endocannabinoids (ECs) play essential roles in regulating stress responses, emotional processing (Hill & Lee, 2016), pain regulation (Lu & Mackie, 2016), regulating appetite, energy balance (Drummen et al., 2020), sleep (Kesner & Lovinger, 2020), and immune responses (Rahaman & Ganguly, 2021). Elevated EC levels, such as Anandamide, indicate greater resilience and effective stress management, supported by studies from Morena et al., 2015 and Mayo et al. (2020).

ECs are markers that reflect how we respond to stress and how it impacts us. In particular, AEA and PEA appear to be directly linked to resilience. Lower levels of AEA in hair may indicate a chronically stressed state, suggesting reduced effectiveness in handling new stressors.

Additionally, habits that promote resilience, such as exercise, have been shown to increase AEA levels, providing further evidence of its role in stress management. Several studies have also demonstrated a positive correlation between PEA and resilience. Moreover, treatment with PEA has shown initial signs of having antidepressant effects, supporting its potential role in building resilience.

While chronic stress has been associated with decreased levels of SEA and OEA, there is currently insufficient evidence to directly link them to resilience. However, due to their connections with anxiety and pro-social behavior, they may still contribute to an individual's overall resilience.

Given the above findings, we created a hair endocannabiod score including 3 endocannabinoids (AEA, 2-AG, PEA) that show highest correlation to resilience-related concepts based on a scientific literature review. We left out SEA and OEA due to insufficient evidence.

1. Anandamide (AEA): AEA is a key neurotransmitter that activates the ECS. Its levels typically decrease during stress but return to normal once the stress subsides. However, during chronic stress, baseline AEA levels are reduced (Morena et al., 2015). Higher AEA levels have been linked to greater stress resilience in individuals (Mayo et al., 2020). Exercise has also been shown to increase AEA levels (Tam et al., 2021).
2. 2-Arachidonoylglycerol (2-AG): 2-AG has a delayed response, becoming active toward the end of a stressful event. Unlike AEA, 2-AG levels increase in response to stress (Morena et al., 2015). There also appears to be an indication that early life stress leads to elevated levels of 2-AG (Koenig et al., 2018, Behnke et al., 2020)
3. N-palmitoylethanolamide (PEA): PEA levels also decline in response to chronic stress and are positively correlated with resilience (Biener et al., 2024).

ECG Monitoring

We further assessed resilience by monitoring sleep quality and daily stress recovery through ECG using Firstbeat devices. Participants’ sleep quality improved by an average of 18%, and daytime heart-rate variability (HRV)—an indicator of stress recovery—increased by 24% (see whitepaper on measurement technique here). These improvements were tracked across representative workweeks (no infection and intercontinental flight 5 days prior to measurement period as well as ‘representative amounts of travel), ensuring accuracy and reliability. Sleep quality was assessed using the Firstbeat ECG monitor and using an approach as outlined in this whitepaper. As HRV scores have limitations regarding the person-to-person comparison, for the resilience score we considered multiple HRV parameters such as HRV variation as well as day-time and night-time HRV.

Self-Assess Resilience

In addition, we used validated self-assessment tools specifically designed to measure resilience: the Brief Resilience Scale  and the Resilience Coping Scale for Adults. The Brief Resilience Scale evaluates participants' ability to bounce back from stress and adversity, while the Resilience Coping Scale assesses their coping strategies and resilience-enhancing behaviors. Selected elements fro these questionnaires were completed before and after the program, providing valuable insights into how participants' perceptions and coping mechanisms evolved alongside biological improvements.

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Energy Leaks

Participants also reported a significant reduction in "energy leaks," with symptoms related to physiological, cognitive, and emotional energy drains typically decreasing by around 20%. We assessed over 70 symptoms across 13 common categories such as metabolic health, hydration, and gut health (using this self-assessment). Participants completed an online assessment before and after the program. Following program participation, individuals reported on average 20% fewer energy-related symptoms.

Attention Regulation

We have started implementing multiple measures of attention in our diagnostics. The results are still coming in for a composite attention regulation score involving dynamic cognitive testing as well as self-assessment of attention regulation skills. Until we have analyzed all results from the Sapiens Diagnostics on Attention Regulation, we are assuming a 16% improvement on a composite attention regulation score of a Sapiens program participants that is engaged in the program and puts mindfulness-based and attention regulation training in place. This number is estimated based on a Randomized Control Trial measuring the impact of short-term meditation training on attention and self-regulation (Tang et al., 2007).

With our Sapiens Stress Diagnostics, we measure these elements of attention regulation:

• Sustained Attention - Sustained Attention refers to the ability to maintain focus and concentration on a specific task or stimulus over an extended period, despite potential internal distractions or fatigue.
  • We measure this with the Self-Regulation Scale by Schwarzer, Diehl, & Schmitz, 1999
    • “I usually have a whole bunch of thoughts and feelings that interfere with my ability to work in a focused way.”
    • “I can concentrate on one activity for a long time, if necessary.”
• Distractability - Distractibility refers to the tendency to be easily diverted or interrupted by irrelevant external stimuli or distractions, impairing one’s ability to maintain focus on the primary task.
  • We meausure this with the Stroop Test as well as the Self-Regulation Scale with questions such as the Attentional Control Scale (ACS) by Derryberry & Reed, 2002
    • “It’s very hard for me to concentrate on a difficult task when there are noises around.”
    • “I have a hard time keeping my attention focused when I’m interrupted.”
• Cognitive Flexibility - it refers to the ability to redirect focus from one task or stimulus to another efficiently.
  • We measure this by the Attentional Control Scale (ACS) by Derryberry & Reed, 2002
    • “I can easily shift my attention between different activities.”
    • “After being interrupted or distracted, I can easilyshift my attention back to what I was doing before.”

Note on the provided program metrics

These outcomes represent preliminary findings. It's important to acknowledge that participants who volunteered for detailed assessments may have been particularly motivated toward behavior change, potentially influencing overall results. A total of 46 clients participated, although not all completed every assessment measure. Continued research and data collection will further validate and refine these impactful findings.