NIH Healing Experience of All Life Stressors (NIH-HEALS)

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About the NIH-HEALS

The National Institutes of Health Healing Experience of All Life Stressors (NIH-HEALS) is a validated instrument designed to assess psychosocial-spiritual well-being (Ameli 2018, Coats 2018, Hendricks 2017). It was initially validated in individuals facing serious or life-limiting illnesses (Young 2016, Hendricks 2017). Since validation of the tool, it has been used with healthcare providers and educators. These studies have shown that the scale is sensitive in measuring psychosocial spiritual healing and well-being and is uniquely applicable to anyone facing life altering stress and trauma. Currently, the NIH HEALS is available in English, four African Languages (Namisango 2022) and Spanish. It is being translated to Hebrew and Ukrainian.

NIH-HEALS 35-Item Scale

Developed by researchers at the NIH Clinical Center, the NIH-HEALS consists of 35 self-report items that evaluate three core domains:

Connection: Encompasses relationships with others, spirituality, and a sense of belonging.
Reflection & Introspection: Involves personal growth, meaning-making, and self-awareness.
Trust & Acceptance: Pertains to acceptance of circumstances and trust in oneself and others.

The scale has demonstrated strong psychometric properties, including high internal consistency (Cronbach’s alpha = 0.89) and reliability (split-half reliability = 0.95).

NIH-HEALS Short Form (NIH-HEALS-SF)

To facilitate broader application in clinical and research settings, a 9-item short form of the NIH-HEALS was developed (Vocci 2025). Using data from 200 participants, researchers applied Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify the most predictive items across the three domains. The NIH-HEALS-SF maintains strong internal consistency (Cronbach’s alpha: 0.75–0.85) and correlates highly with the full scale (p = 0.92–0.96), making it a concise yet robust tool for assessing psychosocial-spiritual well-being.

NIH-HEALS Correlates with Resilience and Mindfulness

Psychosocial-spiritual well-being plays a crucial role in enhancing resilience and mindfulness among patients facing severe or life-limiting medical illnesses (Hendricks 2017, Bagereka 2023). When individuals experience a sense of meaning, connection, and emotional support—whether through relationships, personal beliefs, or spiritual practices—they are better equipped to cope with the psychological and existential challenges of their condition (Coats 2017, Holder 2017). This well-being fosters greater emotional stability, acceptance, and presence, which are key components of mindfulness, and it strengthens the capacity to adapt to adversity, a hallmark of resilience. Together, these factors contribute to improved quality of life and a more holistic approach to healing (Skeath 2017).

NIH-HEALS and Gender Differences

Men and Women differ in their experiences of psycho-social-spiritual healing during serious or life-limiting illness (Luna 2019). Using the NIH-HEALS tool, researchers found that women reported greater engagement with mind-body practices, compassion, gratitude, and positivity, while men rated their pain and illness severity higher and their overall health lower. These gender-based differences suggest that tailored interventions may enhance healing by aligning with distinct emotional and spiritual coping styles.

Application in Psychedelic Research

Dr. Manish Agrawal and colleagues have utilized the NIH-HEALS to evaluate the impact of psilocybin-assisted therapy on psychosocial-spiritual well-being in patients with cancer and major depressive disorder (Shnayder 2022). In a Phase II, single-center, open-label trial, 30 participants received a 25 mg dose of psilocybin, accompanied by preparatory and integration sessions. The NIH-HEALS was administered at baseline and at multiple follow-up points up to 8 weeks post-treatment.

Psilocybin study results indicated significant improvements across all three NIH-HEALS domains:

Connection: Increased by 12.7%
Reflection & Introspection: Increased by 7.7%
Trust & Acceptance: Increased by 22.4%

These findings suggest that psilocybin-assisted therapy may facilitate psychosocial-spiritual growth, as measured by the NIH-HEALS.

Application in Healthcare Providers using Mindfulness and Nature Adventure

A randomized controlled trial (2021–2023) explored how nature-based retreats and virtual mindfulness practices could support COVID-19 healthcare workers (Bagereka 2025). 78 adult participants were assigned to Nature-only, Combined Nature + Mindfulness, or Control groups. While stress levels (Perceived Stress Scale) remained unchanged, well-being scores (NIH-HEALS) improved significantly in the Nature-only and Combined groups. This suggests that nature exposure and holistic interventions can enhance emotional and spiritual resilience, even without reducing perceived stress.

Application In Educators in an 8-week Mindfulness based Program

In an 8-week mindfulness-based program for educators there was notable improvement in psychosocial spiritual well-being as assessed by the NIH HEALS. (Currently being written up for publication). The changes were seen with both the 35-item and the 9-item NIH HEALS measurement instruments.

NIH-HEALS 35-Item Versions

For More Information

Use of NIH-HEALS is free. For registration and permission to use the NIH-HEALS or for further information about scoring, contact:

Ann Berger, MSN, MD
aberger@cc.nih.gov

References

Ameli, Rezvan et al. “The National Institutes of Health measure of Healing Experience of All Life Stressors (NIH-HEALS): Factor analysis and validation.” PLoS ONE 13 (2018): n. pag.

Bagereka, Polycarpe et al. “Psychosocial-spiritual well-being is related to resilience and mindfulness in patients with severe and/or life-limiting medical illness.” BMC Palliative Care 22 (2023): n. pag.

Bagereka, Polycarpe et al. “Effects of a combined nature-based and audio-based virtual mindfulness intervention on stress and wellbeing of COVID-19 healthcare workers: a randomized controlled trial.” PeerJ 13 (2025): n. pag.

Coats, Heather et al. “African American Elders’ Serious Illness Experiences.” Qualitative Health Research 27 (2017): 634 - 648.

Coats, Heather et al. “Using cognitive interviews to improve a Psychological-Social-Spiritual Healing instrument: Voices of aging African Americans with serious illness.” Applied nursing research : ANR 39 (2018): 109-114.

Hendricks, Danetta et al. “An assessment of meaning in life-threatening illness: development of the Healing Experience in All Life Stressors (HEALS).” Patient Related Outcome Measures 8 (2017): 15 - 21.

Holder, Gerard N et al. “Psychosocial experiences in the context of life-threatening illness: The cardiac rehabilitation patient.” Palliative and Supportive Care 13 (2014): 749 - 756.

Luna, Maria Jose et al. “Gender Differences in Psycho-Social-Spiritual Healing.” Journal of Women's Health 28 (2019): 1513 - 1521.

Namisango, Eve et al. “Cross Cultural Adaptation and Cognitive Testing of a Psycho-Social-Spiritual Healing Measure, the NIH Healing Experiences in All Life Stressors-NIH-HEALS.” Global Advances in Health and Medicine 11 (2022): n. pag.

Shnayder, Sarah et al. “Psilocybin-assisted therapy mediates psycho-social-spiritual change in cancer patients as assessed by the NIH-HEALS.” Journal of affective disorders 323 (2022): 592-597.

Skeath, Perry et al. “The Nature of Life-Transforming Changes Among Cancer Survivors.” Qualitative Health Research 23 (2013): 1155 - 1167.

Vocci, Marcelli Cristine et al. “Development of the National Institute of Health Healing Experience of All Life Stressors Short Form (NIH-HEALS-SF).” PLOS Mental Health (2025): n. pag.

Young, William C. et al. “Spirituality in the context of life-threatening illness and life-transforming change.” Palliative and Supportive Care 13 (2014): 653 - 660.

Young, William C. et al. “Supportive medical care in life-threatening illness: A pilot study.” Palliative and Supportive Care 14 (2016): 680 - 685.