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How to use the Impact of Event Scale (IES-R) assessment

Learn more about the IES-R assessment and how you can incorporate it into your practice.

January 24, 2025 • Updated on August 29, 2025

8 min read

Post-traumatic stress disorder is complex, affecting multiple areas of a client’s life. For that reason, an accurate diagnosis is key when you’re developing a treatment plan. Your clinical interview can be helpful in determining a diagnosis, but you can also use assessments to better support your clients. 

For example, the Impact of Event Scale (IES-R) can help you measure different diagnostic criteria of PTSD and how they may be impacting your clients’ everyday life. This commonly used assessment tool can also help you track progress so you can adjust your clients’ treatment plans as needed. Below, learn more about the IES-R assessment and how you can incorporate it into your practice.

What is the Impact of Event Scale?

The Impact of Event Scale, or IES-R, is a 22-item, self-report measure that subjectively assesses distress caused by traumatic events in adults. Taking the IES-R, respondents are asked to identify a specific stressful event and then rate how much they were distressed or bothered in the last seven days by each item listed. 

Based on the DSM-IV criteria for post-traumatic stress-disorder (PTSD), the IES-R is a revised version of an older assessment, which had only fifteen items. So far, the IES-R has not been updated to align with the DSM-V.

IES-R assessment

The IES-R assessment includes the following questions and prompts clients to choose 0 (not at all), 1 (little bit), 2 (moderately), 3 (quite a bit), or 4 (extremely).

During the last seven days with respect to [original stressful life event] how much were you distressed or bothered by these difficulties?


1. Any reminder brought back feelings about it 

2. I had trouble staying asleep. 

3. Other things kept making me think about it. 

4. I felt irritable and angry. 

5. I avoided letting myself get upset when I thought about it or was reminded of it. 

6. I thought about it when I didn’t mean to. 

7. I felt as if it hadn’t happened or wasn’t real

8. I stayed away from reminders about it. 

9. Pictures about it popped into my mind. 

10. I was jumpy and easily startled. 

11. I tried not to think about it. 

12. I was aware that I still had a lot of feelings about it, but I didn’t deal with them. 

13. My feelings about it were kind of numb. 

14. I found myself acting or feeling like I was back at that time. 

15. I had trouble falling asleep. 

16. I had waves of strong feelings about it. 

17. I tried to remove it from my memory. 

18. I had trouble concentrating. 

19. Reminders of it caused me to have physical reactions, such as sweating, trouble breathing. 

20. I had dreams about it. 

21. I felt watchful and on-guard. 

22. I tried not to talk about it.

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IES-R scoring

Each measure on the assessment is measured on a four-point scale and assigned a certain number of points.

Not at all: 0 points

Little bit: 1 point

Moderately: 2 points

Quite a bit: 3 points

Extremely: 4 points

​​When each answer is assigned a point value, the total score for the IES-R assessment can range from 0–88. In general, the higher the score, the more severely a person’s life is disrupted by a traumatic event.

IES-R subscale scoring

The IES-R also contains sub-scale scores that help therapists measure the way stressful life events impact intrusion, avoidance, and hyperarousal in a person’s life—creating a more comprehensive picture of the client and their experience to inform treatment. 

The Intrusion subscale is the mean item response of items 1, 2, 3, 6, 9, 14, 16, 20.

The Avoidance subscale is the mean item response of items 5, 7, 8, 11, 12, 13, 17, 22. 

The Hyperarousal subscale is the mean item response of items 4, 10, 15, 18, 19, 21.

Monitoring changes in IES-R

While it’s often used as a tool for screening and diagnosing PTSD in new clients, the IES-R is also useful in reassessing clients so you can adjust their treatment plan as needed. For example, if you diagnosed a client with PTSD six months ago, you can re-issue the IES-R to determine the current severity of symptoms and adjust your treatment plan as needed.

Find more tools with Headway

Headway’s designed-for-compliance resources and therapist-approved treatment plans help set up mental healthcare providers — and their clients — for success. Consult with a Headway representative to see how we can support you with insurance credentialing, billing, scheduling, and more tools like the IES-R.

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.

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