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    The Hamilton Anxiety Scale (HAM-A): Mild to Moderate Anxiety

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    According to Bech, ‘Hamilton developed, The Hamilton Anxiety Scale (HAM-A) and the Hamilton Depression Scale (HAM-D). The scales have been in existence for over 50 years (Bech, 2009). His main focus was to identify symptoms of the client’s behaviors. (Bech, 2009). This paper will review the experience of taking the Hamilton Anxiety Scale assessment. Secondly, it will entail the expectations, difficulties, and the importance of how the assessment relates to the individual. This paper will incorporate the Marriage and Family Therapy views on ethical considerations while using the Hamilton Anxiety Scale (HAM-A). Finally this paper will examine the test measurement concepts of reliability and validity of each assessment.


    An assessment was completed using the Hamilton Anxiety Scale (HAM-A). The Hamilton Anxiety Rating Scale is one of the first rating scales to measure the severity of perceived anxiety symptoms. It is the most extensively used rating scales. The Hamilton Anxiety Scale (HAM-A) is a standard clinician-based questionnaire and it is self-scored. It involves 14 symptom-defined components. it is both psychological and is comprised of; anxious mood; tension, fears, insomnia, poor memory, difficulty concentrating, depressed mood, somatic symptoms, sensory respiratory, gastrointestinal, genitourinary, autonomic and observed behavior of being restless or fidgety. Each item is scored on a basic numeric scoring of zero meaning the anxiety is not present and up to four being severe (Thompson, 2015).

    The score after taking an individual assessment revealed that the anxiety level was mild to moderate. The experience of taking The Hamilton Anxiety Scale assessment was not surprising. On a daily basis, the individual anxiety level will fluctuate depending on the demands for that day. Some anxieties included; homework assignments being due, teaching a class of four-year-olds, and trying to meet deadlines to finish work within a time limit.

    The expectations before taking the assessment were high. When the assessment presented the questions about the symptoms, there was some hesitation to take the assessment. Not knowing the scores to the end was somewhat stressful. The difficulties in taking the assessment were making sure the questions were answered in truthfulness. One could easily take the assessment without giving a thought about the questions asked. It was very important for the assessment to relate to the individual. According to Whiston, an assessment is described as an objective and standardized measure of a sample of behavior. Assessments observe behavior and describe it with the aid of numerical scales (Whiston, 2017).

    As a marriage and family therapist, assessments are important. There are many instruments used for assessing couples and families. Marriage and family assessments should include instruments that are designed for individual counseling, as well as, instruments for couple and family assessment. As a marriage and family therapist, assessments can provide a therapeutic outlook to promote change in the clients served (Whiston, 2017).

    In Marriage and Family Therapy, there are ethical considerations while using the Hamilton Anxiety Scale (HAM-A). Identified in the AAMFT Code of Ethics, ‘Marriage and family therapists must obtain appropriate informed consent to therapy or related procedures and use language that is reasonably understandable to clients. When persons regardless of age or mental status, are legally incapable of giving informed consent, marriage and family therapists obtain informed permission from a legally authorized person. The content of informed consent may vary depending upon the client and treatment plan. ‘(AAMFT Code of Ethics, 2015).

    What is the Reliability and Validity of the Assessment?

    According to Sullivan, reliability denotes whether an assessment instrument provides the same results each time it is used in the same setting with the same type of subjects. Reliability is a segment of the assessment of validity. Validity is how accurately a study answers the study question or the strength of the study conclusions. Also, validity is how well the assessment tool actually measured Assessment instruments must be both reliable and valid for study results to be credible (Sullivan, 2011).

    Examining, the Hamilton Anxiety Scale (HAM-A) of reliability and validity of the Generalized Anxiety Disorder (GAD) of Wang, Chai, Zhang, Liu, Xie, Zheng, and Fang, ‘The anxiety severity was assessed using the Hamilton Rating Scale for Anxiety (HAMA) with scores of 7to 17which indicated mild anxiety and 18 and above indicated moderate to severe anxiety. Compared with the control group two the values were increased in the anxiety group. The mild anxiety group was less than 5and those with moderate-severe anxiety had greater anxiety’ (Wang, Chai, Zhang, Liu, Xie, Zheng, Fang, 2016). The outcome of the assessment had reliability and validity.

    In examining the Hamilton Rating Scale for Anxiety (HAMA) and comparing it with the Anxious Distress Specifier Interview (DADSI), with Zimmerman, Martin, Clark, McGonigal, Harris and Guzman Holst, ‘The DADSI and HAMA were considerably correlated. The HAMA shared two times as much variance with the HAMD (48%) than did the DADSI (24%). Both the DADSI and HAMA were valid measures of anxiety severity in depressed patients, though the HAMA was more highly confounded with measures of depression than the DADSI'(Zimmerman, Martin, Clark, McGonigal, Harris & Guzman Holst, 2016). In conclusion, the assessment had reliability and validity.

    In viewing the Hamilton Anxiety Scale (HAM-A) of reliability and validity of Diefenbach, Stanley, Beck, Novy, Averill, and Swann, ‘Examination of the Hamilton scales in assessment of anxious older adults’ the study all scales appeared adequate. Results specified improved construct validity with the reconstructed scales, which demonstrated reduced shared variance. But, construct validity examined through inter-correlations of the Hamilton scales with self-report measures of anxiety and depression was normally poor. There is a validity limitation; therefore the validity assessment is not reliable.

    In conclusion, the Hamilton Anxiety Scale (HAM-A) and the Hamilton Depression Scale (HAM-D) is very important in measuring the clients’ anxiety and depressed behaviors(Bech, 2009). It is important that all assessment instruments must be reliable and valid.


    1. Bech, P. (2009). Fifty years with the Hamilton scales for anxiety and depression. Psychotherapy and Psychosomatics, 78(4), 202-11. Retrieved from
    2. Diefenbach, G. J., Stanley, M. A., Beck, J. G., Novy, D. M., Averill, P. M., & Swann, A. C. (2001). Examination of the Hamilton scales in assessment of anxious older adults: A replication and extension. Journal of Psychopathology and Behavioral Assessment, 23(2), 117-124. doi:
    3. Kikas, E., & Jõgi, A. (2016). Assessment of learning strategies: Self-report questionnaire or learning task. European Journal of Psychology of Education, 31(4), 579-593. doi:10.1007/s10212-015-0276-3
    4. Sullivan G. M. (2011). A primer on the validity of assessment instruments. Journal of graduate medical education, 3(2), 119-20.
    5. Thompson, E. (2015).Hamilton Rating Scale for Anxiety (HAM-A) Occupational Medicine, Volume 65, Issue 7,1pages 601. Retrieved from:
    6. Wang, Y., Chai, F., Zhang, H., Liu, X., Xie, P., Zheng, L., Fang, D. (2016). Cortical functional activity in patients with generalized anxiety disorder. BMC Psychiatry, 16 doi:
    7. Whiston, S. C. (2017). Principles and applications of assessment in counseling (5th ed.). Boston, MA: Cengage Learning.
    8. Zimmerman, M., Martin, J., Clark, H., McGonigal, P., Harris L., & Guzman Holst, C., (2016).Measuring anxiety in depressed patients: A comparison of the Hamilton anxiety rating scale and the DSM-5 Anxious Distress Specifier Interview Retrieved from:

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