Self-Transcendence Scale (STS)

Abstract

The Self-Transcendence Scale (STS) is a widely utilized psychometric instrument developed by nursing theorist and developmental researcher Dr. Pamela G. Reed in 1986. Grounded in lifespan developmental psychology and nursing philosophy, the STS measures self-transcendence—conceptualized as the capacity to expand personal boundaries multidimensionally: intrapersonally (toward greater self-acceptance and meaning-making), interpersonally (toward relational connectedness and altruism), transpersonally (connecting with dimensions beyond the observable self, such as nature or spirituality), and temporally (integrating past memories and future perspectives into the present). Comprising 15 self-report items rated on a 4-point Likert-type scale ranging from 1 (Not at all) to 4 (Very much), the STS yields a continuous composite score reflecting an individual’s developmental maturity and capacity for psycho-spiritual well-being during critical life transitions, aging, and severe physical illness.

Extensive psychometric investigations across diverse clinical and non-clinical cohorts—including healthy older adults, palliative oncology patients, individuals diagnosed with chronic illnesses, and family caregivers—have consistently documented the instrument’s robust reliability and validity. Internal consistency reliability estimates typically exhibit Cronbach’s alpha coefficients ranging between .80 and .93, accompanied by acceptable test-retest stability. Exploratory and confirmatory factor analyses demonstrate either an overarching unidimensional construct suitable for global scoring or robust correlated multidimensional frameworks delineating spiritual, interpersonal, and self-integrative boundaries. The STS serves as a cornerstone empirical tool in nursing science, gerontology, palliative care, and positive psychology, operationalizing how human beings achieve existential equilibrium and resilience in the presence of vulnerability.

Keywords

Self-Transcendence Scale, Pamela G. Reed, Self-Transcendence Theory, Lifespan Development, Gerontological Nursing, Psychometrics, Existential Well-Being, Ego Integrity, Palliative Care, Meaning in Life

Authors

The Self-Transcendence Scale was designed and psychometrically validated by Pamela G. Reed, PhD, RN, FAAN. Dr. Reed is a distinguished academician, theorist, and Professor of Nursing at the University of Arizona College of Nursing in Tucson, Arizona, United States. Her pioneering scholarly contributions focus on developmental philosophy, the interface between spirituality and mental health during terminal illness, and middle-range theory construction in clinical nursing science.

Throughout her career, Dr. Reed has spearheaded investigations regarding developmental paradigms in late adulthood, existential resilience among individuals facing end-stage diseases, and theoretical metanarratives bridging empirical psychometrics with holistic health outcomes. Inquiries regarding scale development, operational licensing, and ongoing theoretical adaptations are canonically managed through the University of Arizona College of Nursing.

Purpose

The Self-Transcendence Scale was constructed to quantify the developmental and psychological capacity of individuals to transcend their personal boundaries under both normative developmental circumstances (such as healthy chronological aging) and non-normative life crises (such as terminal diagnoses, sudden physical disability, or severe caregiver burden). Historically, traditional psychological frameworks conceptualized late-life transitions and physical decline through paradigms of loss, cognitive degeneration, and psychological detachment. Dr. Reed developed the STS to introduce an asset-based, growth-oriented operationalization of mature adult development that emphasizes psychological expansion rather than contraction.

Clinical Applications

In clinical environments—particularly in oncology, hospice, palliative medicine, and chronic disease rehabilitation—the STS provides clinicians and interdisciplinary healthcare teams with a structured, empirically validated metric to evaluate an individual’s psychological and spiritual coping reserves. Illness and end-of-life trajectories often precipitate intense existential distress, demoralization, and perceived loss of autonomy. By administering the STS, clinicians can:

• Identify patients experiencing compromised psycho-spiritual adaptation who may benefit from dignity therapy, life-review interventions, or meaning-centered psychotherapy.
• Track longitudinal shifts in personal resilience, existential coherence, and peace during palliative trajectories.
• Assess the psycho-emotional burden experienced by family caregivers, whose vulnerability can compromise their self-care and boundary integrity.

Research Applications

In academic and behavioral research, the STS provides an empirical operationalization of self-transcendence as an independent, mediating, or moderating variable within complex stress-and-coping paradigms. Researchers deploy the instrument to examine:

• The mediating role of self-transcendence between functional impairment and subjective well-being in older adults.
• Interactions between spiritual beliefs, psychological hardiness, and biological markers of stress (e.g., cortisol levels, inflammatory cytokines).
• The structural efficacy of psycho-educational and holistic nursing interventions designed to foster ego integrity, generativity, and quality of life.

Psychological Construct

The psychological construct evaluated by the STS is self-transcendence, which Reed conceptualizes as the expansion of personal boundaries inward, outward, upward, and temporally. Rather than signifying an escapist or purely mystical detachment from worldly reality, self-transcendence represents a dynamic, mature developmental process wherein individuals integrate self-awareness, human interconnectedness, and broader existential contexts.

Figure 1: Conceptual dimensions of boundary expansion within Reed’s Self-Transcendence Theory.

Dimensions of Boundary Expansion

• Intrapersonal Boundary Expansion: Refers to inward reflection, self-acceptance, and psychological accommodation of personal changes. This entails accepting one’s biological aging process, acknowledging physical and cognitive shifts, adapting personal pacing, and integrating historical experiences into a coherent self-concept (e.g., Accepting myself as I grow older, Adjusting to the changes in my physical ability).
• Interpersonal Boundary Expansion: Encompasses relational connectivity, community involvement, generativity, and social exchange. It reflects the willingness to share acquired wisdom with younger generations, engaging meaningfully in social systems, and paradoxically, having the humility to accept assistance from others when needed (e.g., Sharing my wisdom or experience with others, Letting others help me when I may need it).
• Transpersonal Boundary Expansion: Represents the connection to dimensions that surpass the observable physical self, including deep ecological awareness, philosophical frameworks, or spiritual and metaphysical dimensions that impart meaning to life and mortality (e.g., Finding meaning in my spiritual beliefs, Accepting death as a part of life).
• Temporal Boundary Expansion: Involves integrating past, present, and future temporal orientations. Rather than experiencing regret or fixating on unrealized aspirations, temporal expansion allows the individual to reconcile past choices, find value in life history, release unattainable ambitions, and cultivate presence within the current reality (e.g., Finding meaning in my past experiences, Putting aside some things that I once thought were so important).

Theoretical Framework

The STS is theoretically situated within Pamela G. Reed’s Theory of Self-Transcendence, a middle-range nursing theory formulated through the synthesis of lifespan developmental psychology, conceptual frameworks of nursing, and existential philosophy.

Foundational Theoretical Roots

• Lifespan Developmental Psychology: Reed’s theory builds directly upon Erik Erikson‘s epigenetic model of psychosocial development, specifically the culminating stage of Ego Integrity versus Despair. Erikson posited that successful late-life development requires reconciling one’s historical life course and accepting mortality without debilitating regret. Reed also drew upon Robert Peck’s expansions of Erikson, which emphasize ego differentiation, body transcendence, and ego transcendence.
• Martha Rogers’ Science of Unitary Human Beings: Reed incorporated Martha E. Rogers‘ conceptualization of human beings as dynamic, open energy fields continuously interacting within an infinite environmental field. In this perspective, self-transcendence is not an extraordinary, supernatural event, but a normative, continuous manifestation of human complexity and boundary evolution.
• Existential Philosophy and Logotherapy: The construct mirrors Viktor Frankl‘s proposition that the primary human motivation is the will-to-meaning, achieved through creative deeds, experiential encounters, and the attitudinal stance one adopts toward unavoidable suffering.

Core Theoretical Assumptions and Structural Propositions

Reed’s middle-range theory articulates three core conceptual components linked in a dynamic structural network:

1. Vulnerability: The contextual awareness of one’s personal mortality, frailty, or bodily limitations. Vulnerability arises naturally during developmental transitions, aging, illness, or bereavement. Rather than acting solely as a pathogenic stressor, vulnerability serves as an ontological catalyst that triggers developmental boundary expansion.
2. Self-Transcendence: The psychological and spiritual capacity to expand boundaries inwardly, outwardly, upwardly, and temporally in response to vulnerability.
3. Well-Being: The subjective sense of wholeness, psychological equilibrium, and health. The theory explicitly posits that self-transcendence directly enhances well-being and mediates the relationship between vulnerability and mental health outcomes.

Validity

The STS has undergone extensive psychometric validation across healthy, chronically ill, and terminally ill cohorts, establishing its robust construct, convergent, discriminant, and criterion-related validity.

Content and Construct Validity

Initial content validation was executed through comprehensive reviews of gerontological literature and consensus ratings by panels of clinical nurse specialists, developmental psychologists, and gerontologists. Items were calibrated to represent diverse boundary dimensions without disproportionately emphasizing physical functioning, ensuring that individuals with severe physical impairments could score highly based on cognitive, interpersonal, and spiritual adaptations.

Convergent Validity

Construct validity has been verified through statistically significant positive correlations with theoretically aligned psychological scales:

• Purpose in Life: Strong positive correlations have been consistently demonstrated with Crumbaugh and Maholick’s Purpose in Life (PIL) Test, with Pearson product-moment correlation coefficients commonly falling between r = .55 and r = .68 (p < .001).
• Self-Esteem and Coherence: The STS correlates positively with the Rosenberg Self-Esteem Scale (r = .45 to .58) and Antonovsky’s Orientation to Life Questionnaire measuring Sense of Coherence (SOC) (r = .50 to .62).
• Subjective Well-Being: Multiple studies among older adults documented robust positive correlations between the STS and the Life Satisfaction Index-Z (LSI-Z) (r = .52 to .64).

Discriminant Validity

Discriminant validity has been corroborated by demonstrating significant inverse relationships with measures of affective distress and existential isolation:

• Depressive Symptomatology: Significant negative correlations are consistently observed between the STS and the Center for Epidemiologic Studies Depression Scale (CES-D), with correlation coefficients typically ranging from r = -.40 to r = -.61 (p < .001).
• Death Anxiety: STS scores demonstrate inverse correlations with Templer’s Death Anxiety Scale (r = -.30 to -.42), affirming that greater temporal and transpersonal boundary expansion attenuates existential dread.

Cross-Cultural Validity

The scale has undergone formal linguistic translation and cross-cultural validation in numerous languages, including Korean, Swedish, Spanish, Portuguese, Norwegian, Turkish, Chinese, and Persian. These investigations confirm that the construct maintains cultural applicability and psychometric coherence across diverse international populations.

Reliability

The Self-Transcendence Scale consistently demonstrates high reliability across diverse study populations and administration formats.

Internal Consistency Reliability

Across empirical research spanning nearly four decades, the STS has exhibited strong internal consistency:

• In Reed’s foundational studies (1986, 1991) examining hospitalized adults, terminally ill cancer patients, and community-dwelling elderly cohorts, Cronbach’s alpha coefficients ranged between .80 and .93.
• Subsequent studies among female breast cancer survivors (Coward, 1996) demonstrated alpha coefficients of .83 to .88.
• Validations among primary family caregivers of patients with dementia or advanced malignancies yielded alpha values spanning .84 to .91.
• Cross-cultural adaptations have yielded comparable internal consistencies: the Korean version (Kim, 2008) achieved an alpha of .87; the Swedish adaptation (Börneman et al., 2010) reported an alpha of .88; and the Spanish version (Guerrero-Castañeda et al., 2018) documented an alpha of .85.

Test-Retest Stability

Temporal stability assessments over intervals ranging from two to four weeks have demonstrated stability coefficients between r = .78 and r = .88 in stable community cohorts, confirming that while self-transcendence can evolve over long-term developmental trajectories or targeted existential interventions, it behaves as a stable developmental disposition over brief intervals.

Factor Analysis

The structural dimensionality of the STS has been scrutinized using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), eliciting discussions regarding whether the instrument is primarily unidimensional or multidimensional.

Exploratory Factor Analysis (EFA)

In early principal component and common factor analyses conducted by Reed, the STS displayed a dominant primary factor accounting for a substantial proportion of the total item variance (often between 35% and 52%), supporting the computation of a single omnibus composite score. However, when orthogonal (Varimax) or oblique (Promax) rotations were applied, researchers frequently identified a correlated two-, three-, or four-factor structure reflecting the theoretical boundaries:

1. Self-Integration and Adaptability: Comprising items relating to self-acceptance, adjustment to physical aging, and peace with current life pace (e.g., Items 2, 4, 5, 10, 14).
2. Interpersonal and Generative Connectedness: Comprising items reflecting community engagement, mentoring younger generations, and sharing wisdom (e.g., Items 3, 6, 8, 9).
3. Transpersonal / Spiritual Meaning: Comprising items assessing spiritual conviction, acceptance of death, and finding meaning in existence (e.g., Items 7, 11, 12).

Confirmatory Factor Analysis (CFA)

Modern structural equation modeling and CFA evaluations demonstrate that while a single-factor first-order model often exhibits acceptable fit, a second-order hierarchical model (with a global Self-Transcendence higher-order factor governing correlated subdimensions) generally demonstrates superior fit indices:

• Comparative Fit Index (CFI): Values consistently exceed > .92 across validated sample groups.
• Tucker-Lewis Index (TLI): Typically reports values ranging from .90 to .94.
• Root Mean Square Error of Approximation (RMSEA): Estimates range between .045 and .068, indicating good model fit.
• Standardized Factor Loadings: Nearly all items exhibit standardized loadings exceeding λ = .45, with items addressing wisdom-sharing, self-acceptance, and finding meaning in past experiences regularly demonstrating loadings between λ = .60 and λ = .78.

Instrument / Measurement Tool

The technical parameters and administrative specifications of the Self-Transcendence Scale are outlined below:

• Instrument Name: Self-Transcendence Scale (STS)
• Original Author: Pamela G. Reed, PhD, RN, FAAN
• Initial Publication Year: 1986 (subsequent theoretical refinements 1991, 2008, 2014)
• Format: Paper-and-pencil self-report questionnaire, structured interview, or computer-assisted digital assessment
• Target Population: Adults across the lifespan, including healthy older adults, palliative and oncology patients, individuals with chronic illness, and family caregivers
• Item Count: 15 items
• Response Scale: 4-point Likert-type scale:
  • 1 = Not at all
  • 2 = Very little
  • 3 = Somewhat
  • 4 = Very much
• Completion Time: Approximately 5 to 10 minutes
• Scoring System:
  • Items 1 through 14 are keyed positively and scored directly: 1 = 1, 2 = 2, 3 = 3, 4 = 4.
  • Item 15 is negatively worded (“Dwelling on my past unmet dreams or goals”) and must be reverse scored: 1 = 4, 2 = 3, 3 = 2, 4 = 1.
  • Total score is computed by summing all 15 items (after reverse scoring Item 15), yielding a possible theoretical range of 15 to 60.
  • Alternatively, a mean score can be calculated (total sum divided by 15), yielding an index between 1.0 and 4.0.
  • Higher aggregate scores represent greater levels of self-transcendence, developmental maturity, and existential resourcefulness.

Permissions & Fee and Test Year

The Self-Transcendence Scale was initially formulated and published by Dr. Pamela G. Reed in 1986, with extensive psychometric validation published in 1991. The instrument is protected under academic copyright held by Dr. Pamela G. Reed and the University of Arizona College of Nursing.

For academic, educational, and non-funded clinical research purposes, the STS is generally made accessible by the author upon submission of a formal request outlining the study’s protocol, ethical approvals, and institutional affiliations. Commercial applications, sponsored pharmaceutical trials, or integration within proprietary clinical digital platforms require formal written permissions, licensing agreements, and potential royalty fees. Researchers seeking to translate, adapt, or deploy the scale should communicate directly with Dr. Pamela G. Reed via the University of Arizona College of Nursing.

References

• Börneman, S., Bernhardson, B. M., Grundberg, Å., & Castor, C. (2010). Psychometric properties of the Swedish version of the Self-Transcendence Scale. Scandinavian Journal of Caring Sciences, 24(s1), 81–87. https://doi.org/10.1111/j.1471-6712.2009.00762.x
• Coward, D. D. (1996). Self-transcendence and emotional well-being in women with advanced breast cancer. Oncology Nursing Forum, 23(7), 1097–1103.
• Erikson, E. H. (1982). The life cycle completed: A review. W. W. Norton & Company.
• Guerrero-Castañeda, R. F., Menezes, T. M. O. D., & Ojeda-Vargas, M. G. (2018). Characteristics of the Self-Transcendence Scale in Mexican older adults: Psychometric analysis. Revista Latino-Americana de Enfermagem, 26, e3065. https://doi.org/10.1590/1518-8345.2678.3065
• Hunnibell, L. S., Reed, P. G., Quinn-Griffin, M., & Fitzpatrick, J. J. (2008). Self-transcendence and vigor in healthcare professionals. International Journal of Human Caring, 12(4), 45–52. https://doi.org/10.20467/1091-5710.12.4.45
• Kim, S. S. (2008). Interdependence of spirituality and well-being among Korean elders and family caregivers (Doctoral dissertation). The University of Arizona. Available online: https://www.nursing.arizona.edu/Library/081_Kim_Suk-Sun.pdf
• Reed, P. G. (1986). Religiousness among terminally ill and healthy adults. Research in Nursing & Health, 9(1), 35–41. https://doi.org/10.1002/nur.4770090107
• Reed, P. G. (1987). Spirituality and well-being in terminally ill hospitalized adults. Research in Nursing & Health, 10(5), 335–344. https://doi.org/10.1002/nur.4770100508
• Reed, P. G. (1991). Self-transcendence and mental health in oldest-old adults. Nursing Research, 40(1), 5–11. https://doi.org/10.1097/00006199-199101000-00002
• Reed, P. G. (2014). Theory of self-transcendence. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for nursing (3rd ed., pp. 109–139). Springer Publishing Company.
• Rogers, M. E. (1970). An introduction to the theoretical basis of nursing. F. A. Davis Company.
• Runquist, J. J., & Reed, P. G. (2007). Self-transcendence and well-being in homeless adults. Journal of Holistic Nursing, 25(1), 5–13. https://doi.org/10.1177/0898010106295982

13. Items of the Scale (Questionnaire)