Society for Ambulatory Assessment

Second quarter 2015 (April to June)

Aggio, Daniel; Smith, Lee; Hamer, Mark (2015): Effects of reallocating time in different activity intensities on health and fitness: a cross sectional study. In: Int J Behav Nutr Phys Act 12, S. 83. DOI: 10.1186/s12966-015-0249-6.

BACKGROUND: The effects of replacing time in specific activity categories for other categories (e.g. replacing sedentary time with light activity) on health and fitness are not well known. This study used isotemporal substitution to investigate the effects of substituting activity categories in an equal time exchange fashion on health and fitness in young people. METHODS: Participants were drawn from schools in Camden, London (n = 353, mean age 9.3 +/- 2.3 years). Time sedentary, in light and in moderate-to-vigorous activity (MVPA) was measured via accelerometry. The effects of substituting time in activity categories (sedentary, light and MVPA) with equivalent time in another category on health and fitness were examined using isotemporal substitution. RESULTS: In single and partition models, MVPA was favourably associated with body fat %, horizontal jump distance and flexibility. Time sedentary and in light activity were not associated with health and fitness outcomes in these models. In substitution models, replacing one hour of sedentary time with MVPA was favourably associated with body fat % (B = -4.187; 95% confidence interval (CI), -7.233, -1.142), horizontal jump distance (B = 16.093; 95% CI, 7.476, 24.710) and flexibility (B = 4.783; 95% CI, 1.910, 7.656). Replacing time in light activity with MVPA induced similar benefits but there were null effects for replacing sedentary with light intensity. CONCLUSION: Substituting time sedentary and in light activity with MVPA was associated with favourable health and fitness. Time in sedentary behaviour may only be detrimental to health and fitness when it replaces time in MVPA in young people.

Aibar, Alberto; Bois, Julien E.; Generelo, Eduardo; Bengoechea, Enrique García; Paillard, Thierry; Zaragoza, Javier (2015): Effect of weather, school transport, and perceived neighborhood characteristics on moderate to vigorous physical activity levels of adolescents from two European cities. In: Environment and Behavior 47 (4), S. 395–417. DOI: 10.1177/0013916513510399.

The main goal of this study is to analyze the influence of several environmental factors (temperature, precipitation, mode and duration of school transport, perception of physical activity [PA] opportunities, and perceived neighborhood walkability) on adolescent’s daily moderate to vigorous physical activity (MVPA) levels of two European mid-sized cities. Data were collected from a sample of 829 adolescents (49.7% Spanish; 55.2% females; 14.33 ± 0.73 years). Daily meteorological data were collected for the valid days for each subject and MVPA levels were assessed with Actigraph GT3X accelerometer during seven consecutive days. Data were analyzed using multilevel modeling. Warmer weather (p < .01), lower levels of precipitation (p < .05), and use of active school transport (p < .05) were significantly associated with higher MVPA levels. Environmental neighborhood perception did not show significant influence. Further efforts should be carried out to increase PA opportunities during colder periods, rainy days, and to promote the use of active transport.

Aigner, Carrie J.; Cinciripini, Paul M.; Anderson, Karen O.; Baum, George P.; Gritz, Ellen R.; Lam, Cho Y. (2015): The Association of Pain With Smoking and Quit Attempts in an Electronic Diary Study of Cancer Patients Trying to Quit. In: Nicotine Tob Res. DOI: 10.1093/ntr/ntv118.

INTRODUCTION: The purpose of this electronic daily diary study was to examine the relation of pain to smoking and quit attempts among 34 cancer patients with pain enrolled in a smoking cessation program. METHODS: Electronic daily diary assessments of pain and smoking were collected at the end of each day for a 2-week period during smoking cessation treatment. Pain experienced throughout the day was measured on a scale from 1 to 5, from “no pain” to “pain as bad as you can imagine.” Smoking was defined as the number of cigarettes smoked per day. RESULTS: Linear multilevel modeling was used in examining associations between pain and smoking. A within-person pain and smoking association was found, such that greater daily pain was linked to greater daily smoking within individuals, controlling for baseline symptoms, nicotine dependence, smoking urge, age, and gender. No between-person pain and smoking association was observed. Additionally, cancer patients with higher average pain across the 2-week assessment period were less likely to make a quit attempt (defined as a day on which participants smoked no cigarettes) during the study period. CONCLUSIONS: The findings of this study add to a nascent literature on pain and smoking by providing initial evidence that pain may be a barrier to quitting among cancer patients who smoke and have pain. Future research examining the effectiveness of integrated pain and smoking cessation treatment in this population may be warranted.

Alderson-Day, Ben; Fernyhough, Charles (2015): Relations among questionnaire and experience sampling measures of inner speech: a smartphone app study. In: Front Psychol 6, S. 517. DOI: 10.3389/fpsyg.2015.00517.

Inner speech is often reported to be a common and central part of inner experience, but its true prevalence is unclear. Many questionnaire-based measures appear to lack convergent validity and it has been claimed that they overestimate inner speech in comparison to experience sampling methods (which involve collecting data at random timepoints). The present study compared self-reporting of inner speech collected via a general questionnaire and experience sampling, using data from a custom-made smartphone app (Inner Life). Fifty-one university students completed a generalized self-report measure of inner speech (the Varieties of Inner Speech Questionnaire, VISQ) and responded to at least seven random alerts to report on incidences of inner speech over a 2-week period. Correlations and pairwise comparisons were used to compare generalized endorsements and randomly sampled scores for each VISQ subscale. Significant correlations were observed between general and randomly sampled measures for only two of the four VISQ subscales, and endorsements of inner speech with evaluative or motivational characteristics did not correlate at all across different measures. Endorsement of inner speech items was significantly lower for random sampling compared to generalized self-report, for all VISQ subscales. Exploratory analysis indicated that specific inner speech characteristics were also related to anxiety and future-oriented thinking.

Ambwani, Suman; Roche, Michael J.; Minnick, Alyssa M.; Pincus, Aaron L. (2015): Negative affect, interpersonal perception, and binge eating behavior: An experience sampling study. In: Int J Eat Disord. DOI: 10.1002/eat.22410.

OBJECTIVE: Etiological and maintenance models for disordered eating highlight the salience of negative affect and interpersonal dysfunction. This study employed a 14-day experience sampling procedure to assess the impact of negative affect and interpersonal perceptions on binge eating behavior. METHOD: Young adult women (N = 40) with recurrent binge eating and significant clinical impairment recorded their mood, interpersonal behavior, and eating behaviors at six stratified semirandom intervals daily through the use of personal digital assistants. RESULTS: Although momentary negative affect was associated with binge eating behavior, average levels of negative affect over the experience sampling period were not, and interpersonal problems moderated the relationship between negative affect and binge eating. Interpersonal problems also intensified the association between momentary interpersonal perceptions and binge eating behavior. Lagged analyses indicated that previous levels of negative affect and interpersonal style also influence binge eating. DISCUSSION: The study findings suggest there may be important differences in how dispositional versus momentary experiences of negative affect are associated with binge eating. Results also highlight the importance of interpersonal problems for understanding relationships among negative affect, interpersonal perception, and binge eating behavior. These results offer several possibilities for attending to affective and interpersonal functioning in clinical practice. (c) 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015;).

Arora, S.; Venkataraman, V.; Zhan, A.; Donohue, S.; Biglan, K. M.; Dorsey, E. R.; Little, M. A. (2015): Detecting and monitoring the symptoms of Parkinson’s disease using smartphones: A pilot study. In: Parkinsonism & Related Disorders 21 (6), S. 650–653. DOI: 10.1016/j.parkreldis.2015.02.026.

Background: Remote, non-invasive and objective tests that can be used to support expert diagnosis for Parkinson’s disease (PD) are lacking. Methods: Participants underwent baseline in-clinic assessments, including the Unified Parkinson’s Disease Rating Scale (UPDRS), and were provided smartphones with an Android operating system that contained a smartphone application that assessed voice, posture, gait, finger tapping, and response time. Participants then took the smart phones home to perform the five tasks four times a day for a month. Once a week participants had a remote (telemedicine) visit with a Parkinson disease specialist in which a modified (excluding assessments of rigidity and balance) UPDRS performed. Using statistical analyses of the five tasks recorded using the smartphone from 10 individuals with PD and 10 controls, we sought to: (1) discriminate whether the participant had PD and (2) predict the modified motor portion of the UPDRS. Results: Twenty participants performed an average of 2.7 tests per day (68.9% adherence) for the study duration (average of 34.4 days) in a home and community setting. The analyses of the five tasks differed between those with Parkinson disease and those without. In discriminating participants with PD from controls, the mean sensitivity was 96.2% (SD 2%) and mean specificity was 96.9% (SD 1.9%). The mean error in predicting the modified motor component of the UPDRS (range 11–34) was 1.26 UPDRS points (SD 0.16). Conclusion: Measuring PD symptoms via a smartphone is feasible and has potential value as a diagnostic support tool.

Bakshi, Nitya; Stinson, Jennifer N.; Ross, Diana; Lukombo, Ines; Mittal, Nonita; Joshi, Saumya V. et al. (2015): Development, content validity, and user review of a Web-based multidimensional pain diary for adolescent and young adults with sickle cell disease. In: The Clinical Journal of Pain 31 (6), S. 580–590. DOI: 10.1097/AJP.0000000000000195.

Background: Vaso-occlusive pain, the hallmark of sickle cell disease (SCD), is a major contributor to morbidity, poor health-related quality of life, and health care utilization associated with this disease. There is wide variation in the burden, frequency, and severity of pain experienced by patients with SCD. As compared with health care utilization for pain, a daily pain diary captures the breadth of the pain experience and is a superior measure of pain burden and its impact on patients. Electronic pain diaries based on real-time data capture methods overcome methodological barriers and limitations of paper pain diaries, but their psychometric properties have not been formally established in patients with SCD. Objectives: To develop and establish the content validity of a web-based multidimensional pain diary for adolescents and young adults with SCD and conduct an end-user review to refine the prototype. Materials and Methods: Following identification of items, a conceptual model was developed. Interviews with adolescents and young adults with SCD were conducted. Subsequently, end-user review with use of the electronic pain diary prototype was conducted. Results: Two iterative cycles of in-depth cognitive interviews in adolescents and young adults with SCD informed the design and guided the addition, removal, and modification of items in the multidimensional pain diary. Potential end-users provided positive feedback on the design and prototype of the electronic diary. Conclusion: A multidimensional web-based electronic pain diary for adolescents and young adults with SCD has been developed and content validity and initial end-user reviews have been completed.

Barmettler, Gabi; Brawn, Jennifer; Maleki, Nasim; Scrivani, Steven; Burstein, Rami; Becerra, Lino; Borsook, David (2015): A new electronic diary tool for mapping and tracking spatial and temporal head pain patterns in migraine. In: Cephalalgia 35 (5), S. 417–425. DOI: 10.1177/0333102414545892.

Aim: We present an electronic tool for collecting data on the patterns of migraine headache onset and progression. Methods: A digitized map consisting of 44 color-coded segments was defined based on previous reports of migraine pain and the distribution of nerves in the face, head and neck. The map was overlaid on a schematic map of the face, head and neck nerves. Thirty-six patients (N = 36, 28 female/eight male), who met ICDH-II criteria for episodic migraine and had headaches for at least three years, identified all regions where pain typically started and how pain spread and subsequently progressed. Results: Consistent with previous findings, throbbing was the most prevalent quality of migraine pain, always present in 70% of patients surveyed. For the 70% of the patients with throbbing pain, the temple was the onset site of throbbing pain, with no significant difference in the laterality of onset site (58.3% on the right vs. 55.6% on the left hemisphere). The tool was able to capture patterns of pain distribution for throbbing and pressure headache pain and also may be used to assess the change in the pattern of the pain distribution as the disease progresses. Discussion: The pain map survey may be a useful tool for recording and tracking the temporal pattern of migraine onset both for clinical and research purposes. The tool could be used to create maps of pain locations on a large population scale and thus will be a very useful tool in correlating the temporal nature of headache symptoms with potential mechanisms of disease evolution.

Barr, Colin; Marois, Maria; Sim, Ida; Schmid, Christopher H.; Wilsey, Barth; Ward, Deborah et al. (2015): The PREEMPT study – evaluating smartphone-assisted n-of-1 trials in patients with chronic pain: study protocol for a randomized controlled trial. In: Trials 16, S. 67. DOI: 10.1186/s13063-015-0590-8.

BACKGROUND: Chronic pain is prevalent, costly, and clinically vexatious. Clinicians typically use a trial-and-error approach to treatment selection. Repeated crossover trials in a single patient (n-of-1 trials) may provide greater therapeutic precision. N-of-1 trials are the most direct way to estimate individual treatment effects and are useful in comparing the effectiveness and toxicity of different analgesic regimens. The goal of the PREEMPT study is to test the ‘Trialist’ mobile health smartphone app, which has been developed to make n-of-1 trials easier to accomplish, and to provide patients and clinicians with tools for individualizing treatments for chronic pain. METHODS/DESIGN: A randomized controlled trial is being conducted to test the feasibility and effectiveness of the Trialist app. A total of 244 participants will be randomized to either the Trialist app intervention group (122 patients) or a usual care control group (122 patients). Patients assigned to the Trialist app will work with their clinicians to set up an n-of-1 trial comparing two pain regimens, selected from a menu of flexible options. The Trialist app provides treatment reminders and collects data entered daily by the patient on pain levels and treatment side effects. Upon completion of the n-of-1 trial, patients review results with their clinicians and develop a long-term treatment plan. The primary study outcome (comparing Trialist to usual care patients) is pain-related interference with daily functioning at 26 weeks. DISCUSSION: Trialist will allow patients and clinicians to conduct personalized n-of-1 trials. In prior studies, n-of-1 trials have been shown to encourage greater patient involvement with care, which has in turn been associated with better health outcomes. mHealth technology implemented using smartphones may offer an efficient means of facilitating n-of-1 trials so that more patients can benefit from this approach. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02116621 , first registered 15 April 2014.

Barreira, Tiago V.; Zderic, Theodore W.; Schuna, John M Jr; Hamilton, Marc T.; Tudor-Locke, Catrine (2015): Free-living activity counts-derived breaks in sedentary time: Are they real transitions from sitting to standing? In: Gait Posture 42 (1), S. 70–72. DOI: 10.1016/j.gaitpost.2015.04.008.

BACKGROUND: Previous research has demonstrated a link between free-living accelerometer-measured breaks in sedentary time and health related variables. Breaks in sedentary time are typically inferred from time-stamped accelerometer data indicating a transition from lack of movement (recording of <100 activity counts/min) to relatively more movement (>/=100 activity counts/min). However, it remains unknown whether these breaks actually represent sit-to-stand postural transitions in free-living. Thus, the purpose of this study was to compare free-living accelerometer-derived and posture-derived estimates of breaks in sedentary time using the ActiGraph GT3X+ (AG) and the activPAL (AP), respectively. METHODS: A total of 15 participants concurrently wore an AG at their waist and an AP on their right thigh for 7 consecutive days (24h/day – removing them only when in contact with water). Data from both devices were matched on minute-by-minute timestamps while also applying a 3-min allowance window to account for clock drift. Dependent t-test was used to evaluate differences in mean breaks between AG and AP. RESULTS: The AG detected 74+/-4.1 breaks/day (mean+/-SEM) while the AP detected 39+/-3.1 breaks/day (P<0.001). On average, the AG detected 67% of the AP breaks while 65% of the AG breaks did not correspond with AP breaks. Of the non-corresponding AG breaks, 52% occurred when participants were sitting, 42% when standing, and 6% when transitioning from standing to sitting. CONCLUSION: The AG detected a significantly higher number of breaks in sedentary time, the majority of which do not correspond to sit-to-stand transitions as measured by the AP.

Bastyr, Edward J 3rd; Zhang, Shuyu; Mou, Jiani; Hackett, Andy P.; Raymond, Stephen A.; Chang, Annette M. (2015): Performance of an Electronic Diary System for Intensive Insulin Management in Global Diabetes Clinical Trials. In: Diabetes Technol Ther. DOI: 10.1089/dia.2014.0407.

BACKGROUND: This report describes the performance of a wireless electronic diary (e-diary) system for data collection and enhanced patient-investigator interactions during intensive insulin management in diabetes clinical trials. MATERIALS AND METHODS: We implemented a customized electronic communication system featuring an e-diary and a Web portal in three global, randomized, controlled Phase 3 clinical trials testing basal insulin peglispro compared with insulin glargine, both combined with prandial insulin lispro, in patients with type 1 or type 2 diabetes mellitus (T1DM and T2DM, respectively). We collected data during 28 weeks of study e-diary use for the report. RESULTS: Patients (n=2,938) in 31 countries used e-diaries to transmit 2,439,087 blood glucose (BG) values, 96% of which were associated by the patient with a protocol time point during the 72-h response window. Of 208,192 hypoglycemia events captured, 96% had a BG value, and 95% had treatments and outcomes entered by patients within the 72-h window. Patients recorded administration of 1,964,477 insulin doses; 93% of basal insulin doses were adherent with the investigator prescription. Investigators adjusted 13 basal and 92 bolus insulin prescriptions per patient-year using the e-diary system. After 26 weeks of treatment and e-diary use in the combined study arms, hemoglobin A1c values decreased by 0.6% or 1.6% and fasting BG decreased by 7.8 or 28 mg/dL in patients with T1DM or T2DM, respectively. CONCLUSIONS: The e-diary system enabled comprehensive data collection and facilitated communication between investigators and patients for intensive insulin management in three global clinical trials testing basal insulins.

Battista, Susan R.; Mackinnon, Sean P.; Sherry, Simon B.; Barrett, Sean P.; MacNevin, Parnell Davis; Stewart, Sherry H. (2015): Does alcohol reduce social anxiety in daily life? A 22-day experience sampling study. In: Journal of Social and Clinical Psychology 34 (6), S. 508–528. DOI: 10.1521/jscp.2015.34.6.508.

To explain the co-occurrence of social anxiety and alcohol use problems, researchers have used experimental methods to test whether alcohol reduces state social anxiety (SSA) in the lab. The present study used experience sampling to extend research into real world settings. Students (N = 132; 100 women; 32 men; aged 17 to 32 years) reported their SSA and alcohol intake 6 times from 4:00 pm to 4:00 am every day for 22 days. Multilevel modeling suggested for each alcoholic drink consumed, SSA decreased by 4.0% two hours later. Those with greater levels of trait social anxiety (TSA) experienced higher SSA than those with lower levels of TSA. Findings support predictions made by tension reduction theory—that alcohol reduces SSA in daily life. These results extend many lab-based findings to the real world and provide further evidence that alcohol may provide negative reinforcement for those who are experiencing social anxiety.

Bebbington, Paul (2015): Unravelling psychosis: psychosocial epidemiology, mechanism, and meaning. In: Shanghai Arch Psychiatry 27 (2), S. 70–81. DOI: 10.11919/j.issn.1002-0829.215027.

This paper reviews a revolution in our understanding of psychosis over the last 20 years. To a major extent, this has resulted from a process of cross-fertilization between psychosocial epidemiology and cognitive behavior therapy for psychosis (CBT-p). This encouraged complementary strategies for the acquisition and analysis of data. These include the use of a range of dependent variables related to psychosis, and the exploitation of data from cross-sectional and longitudinal epidemiological surveys, virtual reality experiments, experience sampling methodology, and treatment trials. The key element is to investigate social and psychological measures in relation to each other. This research has confirmed the role of the external social world in the development and persistence of psychotic disorder. In addition, several psychological drivers of psychotic experiences have been identified. There is now persuasive evidence that the influence of social factors in psychosis is significantly mediated by non-psychotic symptoms, particularly mood symptoms and other attributes of affect such as insomnia. Psychotic symptoms are also driven by reasoning biases such as jumping to conclusions and belief inflexibility, though little is known about social influences on such biases. It is now clear that there are many routes to psychosis and that it takes many forms. Treatment of all kinds should take account of this: the dependence of CBT-p on a detailed initial formulation in terms of psychological processes and social influences is an example of the required flexibility. Individual mediators are now being targeted in specific forms of CBT-p, with good effect. This in turn corroborates the hypothesized role of non-psychotic symptoms in mediation, and attests to the power of the approaches described.

Ben-Zeev, Dror; Scherer, Emily A.; Wang, Rui; Xie, Haiyi; Campbell, Andrew T. (2015): Next-Generation Psychiatric Assessment: Using Smartphone Sensors to Monitor Behavior and Mental Health. In: Psychiatr Rehabil J. DOI: 10.1037/prj0000130.

OBJECTIVE: Optimal mental health care is dependent upon sensitive and early detection of mental health problems. We have introduced a state-of-the-art method for the current study for remote behavioral monitoring that transports assessment out of the clinic and into the environments in which individuals negotiate their daily lives. The objective of this study was to examine whether the information captured with multimodal smartphone sensors can serve as behavioral markers for one’s mental health. We hypothesized that (a) unobtrusively collected smartphone sensor data would be associated with individuals’ daily levels of stress, and (b) sensor data would be associated with changes in depression, stress, and subjective loneliness over time. METHOD: A total of 47 young adults (age range: 19-30 years) were recruited for the study. Individuals were enrolled as a single cohort and participated in the study over a 10-week period. Participants were provided with smartphones embedded with a range of sensors and software that enabled continuous tracking of their geospatial activity (using the Global Positioning System and wireless fidelity), kinesthetic activity (using multiaxial accelerometers), sleep duration (modeled using device-usage data, accelerometer inferences, ambient sound features, and ambient light levels), and time spent proximal to human speech (i.e., speech duration using microphone and speech detection algorithms). Participants completed daily ratings of stress, as well as pre- and postmeasures of depression (Patient Health Questionnaire-9; Spitzer, Kroenke, & Williams, 1999), stress (Perceived Stress Scale; Cohen et al., 1983), and loneliness (Revised UCLA Loneliness Scale; Russell, Peplau, & Cutrona, 1980). RESULTS: Mixed-effects linear modeling showed that sensor-derived geospatial activity (p < .05), sleep duration (p < .05), and variability in geospatial activity (p < .05), were associated with daily stress levels. Penalized functional regression showed associations between changes in depression and sensor-derived speech duration (p < .05), geospatial activity (p < .05), and sleep duration (p < .05). Changes in loneliness were associated with sensor-derived kinesthetic activity (p < .01). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Smartphones can be harnessed as instruments for unobtrusive monitoring of several behavioral indicators of mental health. Creative leveraging of smartphone sensing could provide novel opportunities for close-to-invisible psychiatric assessment at a scale and efficiency that far exceeds what is currently feasible with existing assessment technologies.

Black, James; Gerdtz, Marie; Nicholson, Pat; Crellin, Dianne; Browning, Laura; Simpson, Julie et al. (2015): Can simple mobile phone applications provide reliable counts of respiratory rates in sick infants and children? An initial evaluation of three new applications. In: International Journal of Nursing Studies 52 (5), S. 963–969. DOI: 10.1016/j.ijnurstu.2015.01.016.

Background: Respiratory rate is an important sign that is commonly either not recorded or recorded incorrectly. Mobile phone ownership is increasing even in resource-poor settings. Phone applications may improve the accuracy and ease of counting of respiratory rates. Objectives: The study assessed the reliability and initial users’ impressions of four mobile phone respiratory timer approaches, compared to a 60-second count by the same participants. Methods: Three mobile applications (applying four different counting approaches plus a standard 60-second count) were created using the Java Mobile Edition and tested on Nokia C1-01 phones. Apart from the 60-second timer application, the others included a counter based on the time for ten breaths, and three based on the time interval between breaths (‘Once-per-Breath’, in which the user presses for each breath and the application calculates the rate after 10 or 20 breaths, or after 60s). Nursing and physiotherapy students used the applications to count respiratory rates in a set of brief video recordings of children with different respiratory illnesses. Limits of agreement (compared to the same participant’s standard 60-second count), intra-class correlation coefficients and standard errors of measurement were calculated to compare the reliability of the four approaches, and a usability questionnaire was completed by the participants. Results: There was considerable variation in the counts, with large components of the variation related to the participants and the videos, as well as the methods. None of the methods was entirely reliable, with no limits of agreement better than −10 to +9 breaths/min. Some of the methods were superior to the others, with ICCs from 0.24 to 0.92. By ICC the Once-per-Breath 60-second count and the Once-per-Breath 20-breath count were the most consistent, better even than the 60-second count by the participants. The 10-breath approaches performed least well. Users’ initial impressions were positive, with little difference between the applications found. Conclusions: This study provides evidence that applications running on simple phones can be used to count respiratory rates in children. The Once-per-Breath methods are the most reliable, outperforming the 60-second count. For children with raised respiratory rates the 20-breath version of the Once-per-Breath method is faster, so it is a more suitable option where health workers are under time pressure.

Blum, Lisa H.; Vakhrusheva, Julia; Saperstein, Alice; Khan, Samira; Chang, Rachel W.; Hansen, Marie C. et al. (2015): Depressed mood in individuals with schizophrenia: A comparison of retrospective and real-time measures. In: Psychiatry Res 227 (2-3), S. 318–323. DOI: 10.1016/j.psychres.2015.03.008.

Depressed mood is prevalent among individuals with schizophrenia, leading to difficulties in functioning. Typically, depressed mood is evaluated using retrospective assessments during which individuals are asked to recall their mood during the past week or month. However, as individuals with schizophrenia may display memory difficulties, the results of such assessments may be biased, potentially leading to inaccurate clinical characterizations and/or suboptimal treatment. Our aim was to assess the potential impact of long-term memory on depressed mood in individuals with schizophrenia. Employing an Experience Sampling Method (ESM) approach, 51 individuals with schizophrenia and 22 healthy controls rated their momentary emotions up to 10 times/day over a two-day period, along with retrospective measures of depressed mood, long-term memory, quality of life, social functioning, and symptoms. ESM assessment of real-time depressed mood demonstrated discriminant and convergent validity. Among the schizophrenia group, there was a significant correlation between the real-time and retrospective measures of depressed mood. However, once variance due to long-term memory was controlled, the relationship between the real-time and retrospective measure was no longer significant. The findings suggest that a real-time measure of depressed mood may allow overcoming some of the limitations associated with long-term memory difficulties common among individuals with schizophrenia.

Bond, Dale S.; Buse, Dawn C.; Lipton, Richard B.; Thomas, J. Graham; Rathier, Lucille; Roth, Julie et al. (2015): Clinical Pain Catastrophizing in Women With Migraine and Obesity. In: Headache. DOI: 10.1111/head.12597.

OBJECTIVE/BACKGROUND: Obesity is related to migraine. Maladaptive pain coping strategies (eg, pain catastrophizing) may provide insight into this relationship. In women with migraine and obesity, we cross-sectionally assessed: (1) prevalence of clinical catastrophizing; (2) characteristics of those with and without clinical catastrophizing; and (3) associations of catastrophizing with headache features. METHODS: Obese women migraineurs seeking weight loss treatment (n = 105) recorded daily migraine activity for 1 month via smartphone and completed the Pain Catastrophizing Scale (PCS). Clinical catastrophizing was defined as total PCS score >/=30. The six-item Headache Impact Test (HIT-6), 12-item Allodynia Symptom Checklist (ASC-12), Headache Management Self-Efficacy Scale (HMSE), and assessments for depression (Centers for Epidemiologic Studies Depression Scale) and anxiety (seven-item Generalized Anxiety Disorder Scale) were also administered. Using PCS scores and body mass index (BMI) as predictors in linear regression, we modeled a series of headache features (ie, headache days, HIT-6, etc) as outcomes. RESULTS: One quarter (25.7%; 95% confidence interval [CI] = 17.2-34.1%) of participants met criteria for clinical catastrophizing: they had higher BMI (37.9 +/- 7.5 vs 34.4 +/- 5.7 kg/m2 , P = .035); longer migraine attack duration (160.8 +/- 145.0 vs 97.5 +/- 75.2 hours/month, P = .038); higher HIT-6 scores (68.7 +/- 4.6 vs 64.5 +/- 3.9, P < .001); more allodynia (7.0 +/- 4.1 vs 4.5 +/- 3.5, P < .003), depression (25.4 +/- 12.4 vs 13.3 +/- 9.2, P < .001), and anxiety (11.0 +/- 5.2 vs 5.6 +/- 4.1, P < .001); and lower self-efficacy (80.1 +/- 25.6 vs 104.7 +/- 18.9, P < .001) compared with participants without clinical catastrophizing. The odds of chronic migraine were nearly fourfold greater in those with (n = 8/29.6%) vs without (n = 8/10.3%) clinical catastrophizing (odds ratio = 3.68; 95%CI = 1.22-11.10, P = .021). In all participants, higher PCS scores were related to more migraine days (beta = 0.331, P = .001), longer attack duration (beta = 0.390, P < .001), higher HIT-6 scores (beta = 0.425, P < .001), and lower HMSE scores (beta = -0.437, P < .001). Higher BMI, but not higher PCS scores, was related to more frequent attacks (beta = -0.203, P = .044). CONCLUSIONS: One quarter of participants with migraine and obesity reported clinical catastrophizing. These individuals had more frequent attacks/chronicity, longer attack duration, higher pain sensitivity, greater headache impact, and lower headache management self-efficacy. In all participants, PCS scores were related to several migraine characteristics, above and beyond the effects of obesity. Prospective studies are needed to determine sequence and mechanisms of relationships between catastrophizing, obesity, and migraine.

Brauch, Rob (2015): How technology megatrends are shaping the future of safety, health, and environmental monitoring. In: Occup Health Saf 84 (5), S. 34-6, 38.

The Safety, Health and Environmental professional will soon be able to choose from a wider number of solutions that incorporate the latest developments in electronics, cellular and wireless communication, sensors, and software, all of which are driven by and are essential components of three “megatrends”–IoT, Big Data, and Social Networking. This will fundamentally alter the way in which we go about collecting information for risk assessment, exposure assessment, and thus how we implement better and more cost-effective solutions for protecting workers’ lives and well-being. The more we become aware of these trends and developments, the better we will be able to integrate them into our sampling strategies and analysis methods, which creates greater value from our daily work as safety and health professionals.

Brinthaupt, Thomas M.; Benson, Scott A.; Kang, Minsoo; Moore, Zaver D. (2015): Assessing the accuracy of self-reported self-talk. In: Front Psychol 6, S. 570. DOI: 10.3389/fpsyg.2015.00570.

As with most kinds of inner experience, it is difficult to assess actual self-talk frequency beyond self-reports, given the often hidden and subjective nature of the phenomenon. The Self-Talk Scale (STS; Brinthaupt et al., 2009) is a self-report measure of self-talk frequency that has been shown to possess acceptable reliability and validity. However, no research using the STS has examined the accuracy of respondents’ self-reports. In the present paper, we report a series of studies directly examining the measurement of self-talk frequency and functions using the STS. The studies examine ways to validate self-reported self-talk by (1) comparing STS responses from 6 weeks earlier to recent experiences that might precipitate self-talk, (2) using experience sampling methods to determine whether STS scores are related to recent reports of self-talk over a period of a week, and (3) comparing self-reported STS scores to those provided by a significant other who rated the target on the STS. Results showed that (1) overall self-talk scores, particularly self-critical and self-reinforcing self-talk, were significantly related to reports of context-specific self-talk; (2) high STS scorers reported talking to themselves significantly more often during recent events compared to low STS scorers, and, contrary to expectations, (3) friends reported less agreement than strangers in their self-other self-talk ratings. Implications of the results for the validity of the STS and for measuring self-talk are presented.

Brondolo, Elizabeth; Monge, Angela; Agosta, John; Tobin, Jonathan N.; Cassells, Andrea; Stanton, Cassandra; Schwartz, Joseph (2015): Perceived ethnic discrimination and cigarette smoking: examining the moderating effects of race/ethnicity and gender in a sample of Black and Latino urban adults. In: J Behav Med 38 (4), S. 689–700. DOI: 10.1007/s10865-015-9645-2.

Perceived ethnic discrimination has been associated with cigarette smoking in US adults in the majority of studies, but gaps in understanding remain. It is unclear if the association of discrimination to smoking is a function of lifetime or recent exposure to discrimination. Some sociodemographic and mood-related risk factors may confound the relationship of discrimination to smoking. Gender and race/ethnicity differences in this relationship have been understudied. This study examines the relationship of lifetime and recent discrimination to smoking status and frequency, controlling for sociodemographic and mood-related variables and investigating the moderating role of race/ethnicity and gender. Participants included 518 Black and Latino(a) adults from New York, US. Lifetime and past week discrimination were measured with the Perceived Ethnic Discrimination Questionnaire-Community Version. Ecological momentary assessment methods were used to collect data on smoking and mood every 20 min throughout one testing day using an electronic diary. Controlling for sociodemographic and mood-related variables, there was a significant association of recent (past week) discrimination exposure to current smoking. Lifetime discrimination was associated with smoking frequency, but not current smoking status. The association of recent discrimination to smoking status was moderated by race/ethnicity and gender, with positive associations emerging for both Black adults and for men. The association of lifetime discrimination on smoking frequency was not moderated by gender or race/ethnicity. Acute race/ethnicity-related stressors may be associated with the decision to smoke at all on a given day; whereas chronic stigmatization may reduce the barriers to smoking more frequently.

Bujarski, Spencer; Roche, Daniel J O; Sheets, Erin S.; Krull, Jennifer L.; Guzman, Iris; Ray, Lara A. (2015): Modeling naturalistic craving, withdrawal, and affect during early nicotine abstinence: A pilot ecological momentary assessment study. In: Exp Clin Psychopharmacol 23 (2), S. 81–89. DOI: 10.1037/a0038861.

Despite the critical role of withdrawal, craving, and positive affect (PA) and negative affect (NA) in smoking relapse, relatively little is known about the temporal and predictive relationship between these constructs within the first day of abstinence. This pilot study aims to characterize dynamic changes in withdrawal, craving, and affect over the course of early abstinence using ecological momentary assessment. Beginning immediately after smoking, moderate and heavy smoking participants (n = 15 per group) responded to hourly surveys assessing craving, withdrawal, NA, and PA. Univariate and multivariate multilevel random coefficient modeling was used to describe the progression of craving, withdrawal/NA, and PA and to test correlations between these constructs at the subject level over the course of early abstinence. Heavy smokers reported greater craving from 1-4 hr of abstinence and greater withdrawal/NA after 3 or more hours as compared with moderate smokers. Level of withdrawal/NA was strongly positively associated with craving, and PA was negatively correlated with craving; however, the temporal dynamics of these correlations differed substantially. The association between withdrawal/NA and craving decreased over early abstinence, whereas the reverse was observed for PA. These findings can inform experimental studies of nicotine abstinence as well as their clinical applications to smoking cessation efforts. In particular, these results help to elucidate the role of PA in nicotine abstinence by demonstrating its independent association with nicotine craving over and above withdrawal/NA. If supported by future studies, these findings can refine experimental methods and clinical approaches for smoking cessation.

Burgin, Chris J.; Chun, Charlotte A.; Horton, Leslie E.; Barrantes-Vidal, Neus; Kwapil, Thomas R. (2015): Splitting of associative threads: The expression of schizotypal ambivalence in daily life. In: Journal of Psychopathology and Behavioral Assessment 37 (2), S. 349–357. DOI: 10.1007/s10862-014-9457-7.

Ambivalence, which refers to the simultaneous experience of contradictory emotions and cognitions, has a longstanding and important role in the study of both normal and pathological functioning. Bleuler and Meehl viewed ambivalence as a central component of schizophrenic, and more broadly schizotypic, psychopathology. Ambivalence is associated with questionnaire and interview measures of schizotypic symptoms and impairment. However, its real-world expression has not been explored. The present study examined the expression of ambivalence, as assessed by the Schizotypal Ambivalence Scale, in daily life using experience sampling methodology. Specifically, it examined the association of ambivalence with affect, daily activities, and social and cognitive functioning in the moment. A sample of 430 male and female young adults completed an average of 42 daily life assessments during a one-week period. Ambivalence predicted diminished positive affect, increased negative affect, cognitive impairment, and social impairment. Furthermore, ambivalence moderated the effects of social closeness, emotional expression, and activity enjoyment on affect and functioning in daily life. Specifically, ambivalence was associated with affective dysregulation and greater reactivity to social stress. The present findings provided the first examination of the expression of ambivalence in daily life and support its inclusion as a component of schizophrenia-spectrum psychopathology.

Byron, Timothy P.; Fowles, Lucinda C. (2015): Repetition and recency increases involuntary musical imagery of previously unfamiliar songs. In: Psychology of Music 43 (3), S. 375–389. DOI: 10.1177/0305735613511506.

We investigated the effect of repetition, recency, and levels of processing on the induction of involuntary musical imagery of previously unfamiliar songs. In an experimental session where participants heard an unfamiliar song, we manipulated song familiarity (participants heard the song either two or six times) and levels of processing (participants either had to answer general questions about the song or questions about how the song related to their life), followed by 3 days of probe-caught experience sampling. In a sample of 36 participants, we found that involuntary musical imagery induced by stimulus songs occurred more often when songs were more familiar, and more often during the earlier part of the experience sampling period. However, levels of processing did not affect rates of involuntary musical imagery.

Ceja, Enrique; Osmani, Venet; Mayora, Oscar (2015): Automatic Stress Detection in Working Environments from Smartphones’ Accelerometer Data: A First Step. In: IEEE J Biomed Health Inform. DOI: 10.1109/JBHI.2015.2446195.

Increase in workload across many organisations and consequent increase in occupational stress is negatively affecting the health of the workforce. Measuring stress and other human psychological dynamics is difficult due to subjective nature of selfreporting and variability between and within individuals. With the advent of smartphones it is now possible to monitor diverse aspects of human behaviour, including objectively measured behaviour related to psychological state and consequently stress. We have used data from the smartphone’s built-in accelerometer to detect behaviour that correlates with subjects stress levels. Accelerometer sensor was chosen because it raises fewer privacy concerns (in comparison to location, video or audio recording, for example) and because its low power consumption makes it suitable to be embedded in smaller wearable devices, such as fitness trackers. 30 subjects from two different organizations were provided with smartphones. The study lasted for 8 weeks and was conducted in real working environments, with no constraints whatsoever placed upon smartphone usage. The subjects reported their perceived stress levels three times during their working hours. Using combination of statistical models to classify self reported stress levels, we achieved a maximum overall accuracy of 71% for user-specific models and an accuracy of 60% for the use of similar-users models, relying solely on data from a single accelerometer.

Cho, Jaehee (2015): Roles of Smartphone App Use in Improving Social Capital and Reducing Social Isolation. In: Cyberpsychol Behav Soc Netw 18 (6), S. 350–355. DOI: 10.1089/cyber.2014.0657.

This study investigated the relationships among smartphone app use, social capital, and social isolation. It focused on two different smartphone apps-communication and social networking site (SNS) apps-and their effects on bonding and bridging social capital. Generational differences in smartphone use were also considered. Results from hierarchical regression analyses indicated that individuals’ use of communication apps was helpful for increasing social capital and that this effect of using communication apps was stronger among those of the millennial generation than among older users. Moreover, bonding and bridging social capital was found to reduce individuals’ social isolation significantly. These results imply the notable role of smartphone apps in reducing social isolation and improving the personal lives of individuals.

Cho, Sung-Bae (2015): Exploiting machine learning techniques for location recognition and prediction with smartphone logs. In: Neurocomputing: An International Journal. DOI: 10.1016/j.neucom.2015.02.079.

Due to the advancement of mobile computing technology and the various sensors built in the smartphones, context-aware services are proliferating to everyday life. Location-based service (LBS), which provides the appropriate service to smartphone users according to their contexts, is becoming more popular, and the location is one of the most important contexts in LBS. Extracting and recognizing meaningful location and predicting next location are crucial for successful LBS. Many researchers have attempted to recognize and predict locations by various methods, but only few consider the development of real working system considering key tasks of LBS on the mobile platform. In this paper, we propose a location recognition and prediction system in smartphone environment, which consists of recognizing location and predicting destination for users. It recognizes user location by combining k-nearest neighbor and decision trees, and predicts user destination using hidden Markov models. To show the usefulness of the proposed system, we have conducted thorough experiments on real everyday life datasets collected from 10 persons for six months, and confirmed that the proposed system yielded above 90% of average location prediction accuracy.

Christiansen, Paul; Schoenmakers, Tim M.; Field, Matt (2015): Less than meets the eye: Reappraising the clinical relevance of attentional bias in addiction. In: Addictive Behaviors 44, S. 43–50. DOI: 10.1016/j.addbeh.2014.10.005.

Recent years have seen an explosion of interest in attentional bias in addiction, particularly its clinical relevance. Specifically, numerous articles claimed to demonstrate either that (1) attentional bias measured in treatment settings could predict subsequent relapse to substance use, or (2) direct modification of attentional bias reduced substance use and improved treatment outcomes. In this paper, we critically evaluate empirical studies that investigated these issues. We show that the evidence regarding both of these claims is decidedly mixed, and that many of the studies that appear to yield positive findings have serious methodological and statistical limitations. We contend that the available literature suggests that attentional bias for drug cues fluctuates within individuals because it is an output of the underlying motivational state at that moment in time, but there is no convincing evidence that it exerts a causal influence on substance use. Future research should make use of experience sampling methodology to characterise the clinical significance of fluctuations in attentional bias over time.

Clough, Bonnie A.; Casey, Leanne M. (2015): The smart therapist: A look to the future of smartphones and mHealth technologies in psychotherapy. In: Professional Psychology: Research and Practice 46 (3), S. 147–153. DOI: 10.1037/pro0000011.

mHealth refers to the use of mobile technologies in the provision of health care and is an expanding field within psychotherapy research. Mobile technologies have the capacity to greatly enhance patient access, uptake, and engagement in psychological treatment. The purpose of the present article is to define mHealth within clinical psychology, provide a review and discussion of the functionality of mHealth devices, current trends within the field of psychological mHealth, the challenges faced by researchers and clinicians in this field, and examine directions for future research. The main areas of research identified included the use of SMS technologies, ecological momentary assessment, online and software application-based interventions and the recent integration of sensor and data mining technologies. Much of the research to date is lacking in methodological rigor, and reliance on standard research designs often used in other areas of psychological research may constrain development of interventions. Research indicates that consumers want to engage in mHealth interventions, although only a limited number of empirically supported options currently exist. Future research incorporating innovative trial designs is required to meet consumer demand and provide users with evidence-based treatment options.

Comulada, W. Scott (2014): Mobile Phone Assessment in Egocentric Networks: A Pilot Study on Gay Men and Their Peers. In: Connect (Tor) 34 (1-2), S. 43–51.

Mobile phone-based data collection encompasses the richness of social network research. Both individual-level and network-level measures can be recorded. For example, health-related behaviors can be reported via mobile assessment. Social interactions can be assessed by phone-log data. Yet the potential of mobile phone data collection has largely been untapped. This is especially true of egocentric studies in public health settings where mobile phones can enhance both data collection and intervention delivery, e.g. mobile users can video chat with counselors. This is due in part to privacy issues and other barriers that are more difficult to address outside of academic settings where most mobile research to date has taken place. In this article, we aim to inform a broader discussion on mobile research. In particular, benefits and challenges to mobile phone-based data collection are highlighted through our mobile phone-based pilot study that was conducted on egocentric networks of 12 gay men (n = 44 total participants). HIV-transmission and general health behaviors were reported through a mobile phone-based daily assessment that was administered through study participants’ own mobile phones. Phone log information was collected from gay men with Android phones. Benefits and challenges to mobile implementation are discussed, along with the application of multi-level models to the type of longitudinal egocentric data that we collected.

Comulada, W. Scott; Lightfoot, Marguerita; Swendeman, Dallas; Grella, Christine; Wu, Nancy (2015): Compliance to Cell Phone-Based EMA Among Latino Youth in Outpatient Treatment. In: J Ethn Subst Abuse, S. 1–19. DOI: 10.1080/15332640.2014.986354.

Outpatient treatment practices for adolescent substance users utilize retrospective self-report to monitor drug use. Cell phone-based ecological momentary assessment (CEMA) overcomes retrospective self-report biases and can enhance outpatient treatment, particularly among Latino adolescents, who have been understudied with regard to CEMA. This study explores compliance to text message-based CEMA with youth (n = 28; 93% Latino) in outpatient treatment. Participants were rotated through daily, random, and event-based CEMA strategies for 1-month periods. Overall compliance was high (>80%). Compliance decreased slightly over the study period and was less during random versus daily strategies and on days when alcohol use was retrospectively reported. Findings suggest that CEMA is a viable monitoring tool for Latino youth in outpatient treatment, but further study is needed to determine optimal CEMA strategies, monitoring time periods, and the appropriateness of CEMA for differing levels of substance use.

Conner, Tamlin S.; Brookie, Kate L.; Richardson, Aimee C.; Polak, Maria A. (2015): On carrots and curiosity: Eating fruit and vegetables is associated with greater flourishing in daily life. In: British Journal of Health Psychology 20 (2), S. 413–427. DOI: 10.1111/bjhp.12113.

Objectives: Our aim was to determine whether eating fruit and vegetables (FV) is associated with other markers of well‐being beyond happiness and life satisfaction. Towards this aim, we tested whether FV consumption is associated with greater eudaemonic well‐being—a state of flourishing characterized by feelings of engagement, meaning, and purpose in life. We also tested associations with two eudaemonic behaviours—curiosity and creativity. Design: Daily diary study across 13 days (micro‐longitudinal, correlational design). Methods: A sample of 405 young adults (67% women; mean age 19.9 [SD 1.6] years) completed an Internet daily diary for 13 consecutive days. Each day, participants reported on their consumption of fruit, vegetables, sweets, and chips, as well as their eudaemonic well‐being, curiosity, creativity, positive affect (PA), and negative affect. Between‐person associations were analysed on aggregated data. Within‐person associations were analysed using multilevel models controlling for weekday and weekend patterns. Results: Fruit and vegetables consumption predicted greater eudaemonic well‐being, curiosity, and creativity at the between‐ and within‐person levels. Young adults who ate more FV reported higher average eudaemonic well‐being, more intense feelings of curiosity, and greater creativity compared with young adults who ate less FV. On days when young adults ate more FV, they reported greater eudaemonic well‐being, curiosity, and creativity compared with days when they ate less FV. FV consumption also predicted higher PA, which mostly did not account for the associations between FV and the other well‐being variables. Few unhealthy foods (sweets, chips) were related to well‐being except that consumption of sweets was associated with greater curiosity and PA at the within‐person level. Lagged data analyses showed no carry‐over effects of FV consumption onto next‐day well‐being (or vice versa). Conclusions Although these patterns are strictly correlational, this study provides the first evidence that FV consumption may be related to a broader range of well‐being states that signal human flourishing in early adulthood.

Conroy, David E.; Ram, Nilam; Pincus, Aaron L.; Coffman, Donna L.; Lorek, Amy E.; Rebar, Amanda L.; Roche, Michael J. (2015): Daily physical activity and alcohol use across the adult lifespan. In: Health Psychology 34 (6), S. 653–660. DOI: 10.1037/hea0000157.

Objective: In contrast to proposals that physical activity (PA) can be a substitute for alcohol use, people who engage in greater overall PA generally consume more alcohol on average than less-active peers. Acknowledging that both PA and alcohol use vary considerably from day-to-day, this study evaluated whether established associations reflect daily behavioral coupling within-person, are an artifact of procedures that aggregate behavior over time, or both. Methods: A life span sample of 150 adults (aged 19–89 years) completed three 21-day measurement bursts of a daily diary study. At the end of each day, they reported on their PA and alcohol consumption. Data were analyzed in a negative binomial multilevel regression. Results: As expected, both behaviors exhibited limited between-person variation. After controlling for age, gender, and seasonal and social calendar influences, daily deviations in PA were significantly associated with daily total alcohol use. Once the within-person process linking PA and alcohol use was controlled, usual PA and total alcohol use were not associated. Conclusions: The established between-person association linking PA and alcohol use reflects the aggregation of a daily process that unfolds within-people over time. Further work is needed to identify mediators of this daily association and to evaluate causality, as well as to investigate these relations in high-risk samples.

Crane, David; Garnett, Claire; Brown, James; West, Robert; Michie, Susan (2015): Behavior change techniques in popular alcohol reduction apps: content analysis. In: J Med Internet Res 17 (5), S. e118. DOI: 10.2196/jmir.4060.

BACKGROUND: Mobile phone apps have the potential to reduce excessive alcohol consumption cost-effectively. Although hundreds of alcohol-related apps are available, there is little information about the behavior change techniques (BCTs) they contain, or the extent to which they are based on evidence or theory and how this relates to their popularity and user ratings. OBJECTIVE: Our aim was to assess the proportion of popular alcohol-related apps available in the United Kingdom that focus on alcohol reduction, identify the BCTs they contain, and explore whether BCTs or the mention of theory or evidence is associated with app popularity and user ratings. METHODS: We searched the iTunes and Google Play stores with the terms “alcohol” and “drink”, and the first 800 results were classified into alcohol reduction, entertainment, or blood alcohol content measurement. Of those classified as alcohol reduction, all free apps and the top 10 paid apps were coded for BCTs and for reference to evidence or theory. Measures of popularity and user ratings were extracted. RESULTS: Of the 800 apps identified, 662 were unique. Of these, 13.7% (91/662) were classified as alcohol reduction (95% CI 11.3-16.6), 53.9% (357/662) entertainment (95% CI 50.1-57.7), 18.9% (125/662) blood alcohol content measurement (95% CI 16.1-22.0) and 13.4% (89/662) other (95% CI 11.1-16.3). The 51 free alcohol reduction apps and the top 10 paid apps contained a mean of 3.6 BCTs (SD 3.4), with approximately 12% (7/61) not including any BCTs. The BCTs used most often were “facilitate self-recording” (54%, 33/61), “provide information on consequences of excessive alcohol use and drinking cessation” (43%, 26/61), “provide feedback on performance” (41%, 25/61), “give options for additional and later support” (25%, 15/61) and “offer/direct towards appropriate written materials” (23%, 14/61). These apps also rarely included any of the 22 BCTs frequently used in other health behavior change interventions (mean 2.46, SD 2.06). Evidence was mentioned by 16.4% of apps, and theory was not mentioned by any app. Multivariable regression showed that apps including advice on environmental restructuring were associated with lower user ratings (Beta=-46.61, P=.04, 95% CI -91.77 to -1.45) and that both the techniques of “advise on/facilitate the use of social support” (Beta=2549.21, P=.04, 95% CI 96.75-5001.67) and the mention of evidence (Beta=1376.74, P=.02, 95%, CI 208.62-2544.86) were associated with the popularity of the app. CONCLUSIONS: Only a minority of alcohol-related apps promoted health while the majority implicitly or explicitly promoted the use of alcohol. Alcohol-related apps that promoted health contained few BCTs and none referred to theory. The mention of evidence was associated with more popular apps, but popularity and user ratings were only weakly associated with the BCT content.

Debusscher, Jonas; Hofmans, Joeri; Fruyt, Filip de (2015): Do personality states predict momentary task performance? The moderating role of personality variability. In: Journal of Occupational and Organizational Psychology. DOI: 10.1111/joop.12126.

We investigated how state neuroticism and state conscientiousness related to momentary task performance and tested whether these relationships were affected by the extent to which a person varies in his level of state neuroticism/conscientiousness across situations. We hypothesized that state neuroticism relates negatively, while state conscientiousness relates positively to momentary task performance. Moreover, for both personality dimensions, we expected the state personality–momentary task performance relationship to be stronger for employees who behave, feel, and think more consistently across situations. These hypotheses were tested using a 10‐day experience sampling study in a large financial institution. Multilevel regression analyses revealed that state neuroticism related negatively and state conscientiousness positively to momentary task performance. Moreover, the relationship between state conscientiousness and momentary task performance was stronger for people lower in situational within‐person conscientiousness variability. From a theoretical point of view, our findings suggest that personality states relate to momentary task performance and that this relationship is stronger for people low in situational within‐person variability. From a practical point of view, they emphasize the importance of taking into account an employee’s state personality levels and the variability herein, in addition to assessing his/her overall trait level of personality. Practitioner points Apart from the stable between‐person differences in personality (i.e., personality traits), a recruiter should also gain insight into situation‐related fluctuations in the candidate’s personality states, which will allow the recruiter to determine how this candidate will perform in these situations. Recruiters should weigh the information they get from personality assessments differently for people showing low levels of situational within‐person (personality) variability compared to those who are high in situational within‐person (personality) variability.

Di Pan; Dhall, Rohit; Lieberman, Abraham; Petitti, Diana B. (2015): A mobile cloud-based Parkinson’s disease assessment system for home-based monitoring. In: JMIR Mhealth Uhealth 3 (1), S. e29. DOI: 10.2196/mhealth.3956.

BACKGROUND: Parkinson’s disease (PD) is the most prevalent movement disorder of the central nervous system, and affects more than 6.3 million people in the world. The characteristic motor features include tremor, bradykinesia, rigidity, and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients’ motor performance but often leads to levodopa-induced adverse effects, such as dyskinesia and motor fluctuation. Clinicians must regularly monitor patients in order to identify these effects and other declines in motor function as soon as possible. Current clinical assessment for Parkinson’s is subjective and mostly conducted by brief observations made during patient visits. Changes in patients’ motor function between visits are hard to track and clinicians are not able to make the most informed decisions about the course of therapy without frequent visits. Frequent clinic visits increase the physical and economic burden on patients and their families. OBJECTIVE: In this project, we sought to design, develop, and evaluate a prototype mobile cloud-based mHealth app, “PD Dr”, which collects quantitative and objective information about PD and would enable home-based assessment and monitoring of major PD symptoms. METHODS: We designed and developed a mobile app on the Android platform to collect PD-related motion data using the smartphone 3D accelerometer and to send the data to a cloud service for storage, data processing, and PD symptoms severity estimation. To evaluate this system, data from the system were collected from 40 patients with PD and compared with experts’ rating on standardized rating scales. RESULTS: The evaluation showed that PD Dr could effectively capture important motion features that differentiate PD severity and identify critical symptoms. For hand resting tremor detection, the sensitivity was .77 and accuracy was .82. For gait difficulty detection, the sensitivity was .89 and accuracy was .81. In PD severity estimation, the captured motion features also demonstrated strong correlation with PD severity stage, hand resting tremor severity, and gait difficulty. The system is simple to use, user friendly, and economically affordable. CONCLUSIONS: The key contribution of this study was building a mobile PD assessment and monitoring system to extend current PD assessment based in the clinic setting to the home-based environment. The results of this study proved feasibility and a promising future for utilizing mobile technology in PD management.

Dontje, Manon L.; Groot, Martijn de; Lengton, Remko R.; van der Schans, Cees P; Krijnen, Wim P. (2015): Measuring steps with the Fitbit activity tracker: an inter-device reliability study. In: J Med Eng Technol 39 (5), S. 286–290. DOI: 10.3109/03091902.2015.1050125.

Activity trackers like Fitbit are used for self-tracking of physical activity by an increasing number of individuals. Comparing physical activity scores with peers can contribute to the desired behavioural change. However, for meaningful social comparison a high inter-device reliability is paramount. This study aimed to determine the inter-device reliability of Fitbit activity trackers in measuring steps. Ten activity trackers (Fitbit Ultra) were worn by a single person (male, 46 years) during eight consecutive days. Inter-device reliability was assessed on three different levels of aggregation (minutes, hours, days) with various methods, including intra-class correlation coefficient (ICC), Bland-Altman plots, limits of agreement (LOA) and Mixed Model Analysis. Results showed that the inter-device reliability of the Fitbit in measuring steps is good at all levels of aggregation (minutes, hours, days), but especially when steps were measured per day. This implies that individuals can reliably compare their daily physical activity scores with peers.

Dunton, Genevieve F.; Liao, Yue; Dzubur, Eldin; Leventhal, Adam M.; Huh, Jimi; Gruenewald, Tara et al. (2015): Investigating within-day and longitudinal effects of maternal stress on children’s physical activity, dietary intake, and body composition: Protocol for the MATCH study. In: Contemp Clin Trials 43, S. 142–154. DOI: 10.1016/j.cct.2015.05.007.

Parental stress is an understudied factor that may compromise parenting practices related to children’s dietary intake, physical activity, and obesity. However, studies examining these associations have been subject to methodological limitations, including cross-sectional designs, retrospective measures, a lack of stress biomarkers, and the tendency to overlook momentary etiologic processes occurring within each day. This paper describes the recruitment, data collection, and data analytic protocols for the MATCH (Mothers And Their Children’s Health) study, a longitudinal investigation using novel real-time data capture strategies to examine within-day associations of maternal stress with children’s physical activity and dietary intake, and how these effects contribute to children’s obesity risk. In the MATCH study, 200 mothers and their 8 to 12year-old children are participating in 6 semi-annual assessment waves across 3years. At each wave, measures for mother-child dyads include: (a) real-time Ecological Momentary Assessment (EMA) of self-reported daily psychosocial stressors (e.g., work at a job, family demands), feeling stressed, perceived stress, parenting practices, dietary intake, and physical activity with time and location stamps; (b) diurnal salivary cortisol patterns, accelerometer-monitored physical activity, and 24-hour dietary recalls; (c) retrospective questionnaires of sociodemographic, cultural, family, and neighborhood covariates; and (d) height, weight, and waist circumference. Putative within-day and longitudinal effects of maternal stress on children’s dietary intake, physical activity, and body composition will be tested through multilevel modeling and latent growth curve models, respectively. The results will inform interventions that help mothers reduce the negative effects of stress on weight-related parenting practices and children’s obesity risk.

Dunton, Genevieve Fridlund; Liao, Yue; Intille, Stephen; Huh, Jimi; Leventhal, Adam (2015): Momentary Assessment of Contextual Influences on Affective Response During Physical Activity. In: Health Psychol. DOI: 10.1037/hea0000223.

OBJECTIVE: Higher positive and lower negative affective response during physical activity may reinforce motivation to engage in future activity. However, affective response during physical activity is typically examined under controlled laboratory conditions. This research used ecological momentary assessment (EMA) to examine social and physical contextual influences on momentary affective response during physical activity in naturalistic settings. METHOD: Participants included 116 adults (mean age = 40.3 years, 73% female) who completed 8 randomly prompted EMA surveys per day for 4 days across 3 semiannual waves. EMA surveys measured current activity level, social context, and physical context. Participants also rated their current positive and negative affect. Multilevel models assessed whether momentary physical activity level moderated differences in affective response across contexts controlling for day of the week, time of day, and activity intensity (measured by accelerometer). RESULTS: The Activity Level x Alone interaction was significant for predicting positive affect (beta = -0.302, SE = 0.133, p = .024). Greater positive affect during physical activity was reported when with other people (vs. alone). The Activity Level x Outdoors interaction was significant for predicting negative affect (beta = -0.206, SE = 0.097, p = .034). Lower negative affect during physical activity was reported outdoors (vs. indoors). CONCLUSIONS: Being with other people may enhance positive affective response during physical activity, and being outdoors may dampen negative affective response during physical activity.

Erbas, Yasemin; Ceulemans, Eva; Koval, Peter; Kuppens, Peter (2015): The role of valence focus and appraisal overlap in emotion differentiation. In: Emotion 15 (3), S. 373–382. DOI: 10.1037/emo0000039.

Emotion differentiation refers to the level of specificity with which people distinguish between their emotional states and is considered to play an important role for psychological well-being. Yet, not much is known about what characterizes people high or low in emotion differentiation and what underlies these differences. In 2 studies involving experience sampling (Studies 1–2) and lab based (Study 2) methods, we investigated how emotion differentiation is related to individual differences in valence focus and the overlap in appraisal patterns between emotions. In line with expectations, results showed that high levels of both positive and negative emotion differentiation are related to lower levels of valence focus and lower levels of appraisal overlap between emotions. These findings suggest that individuals who are low in emotion differentiation mainly emphasize the valence aspect of emotions while individuals who are high in emotion differentiation make stronger distinctions between emotions in terms of their underlying appraisal profiles.

Fatseas, Melina; Serre, Fuschia; Alexandre, Jean‐Marc; Debrabant, Romain; Auriacombe, Marc; Swendsen, Joel (2015): Craving and substance use among patients with alcohol, tobacco, cannabis or heroin addiction: A comparison of substance‐ and person‐specific cues. In: Addiction 110 (6), S. 1035–1042. DOI: 10.1111/add.12882.

Background and aims: It is well established that craving increases following exposure to substance‐related ‘cues’, but the role of life‐styles or substance use habits that are unique to each person remains poorly understood. This study examines the association of substance‐specific and personal cues with craving and substance use in daily life. Design: Ecological momentary assessment was used during a 2‐week period. Setting: Data were collected in a French out‐patient addiction treatment centre. Participants: A total of 132 out‐patients beginning treatment for alcohol, tobacco, cannabis or opiate addiction were included. Measurements: Using mobile technologies, participants were questioned four times per day relative to craving, substance use and exposure to either substance‐specific cues (e.g. seeing a syringe) or personal cues unique to that individual (e.g. seeing the specific person with whom the substance is used). Findings: Craving intensity was associated with the number of concurrently assessed substance‐specific cues (t = 4.418, P < 0.001) and person‐specific cues (t = 4.006, P < 0.001) when analysed jointly within the same model. However, only person‐specific cues were associated with increases in craving over subsequent hours of the day (t = 2.598, P < 0.05). Craving intensity, in turn, predicted increases in later substance use (t = 4.076, P < 0.001). Causal mediation analyses demonstrated that the association of cues with later substance use was mediated by craving intensity (mediated effect = 0.007, 95% confidence interval = 0.004–0.011). Conclusions: Unique person‐specific cues appear to have a robust effect on craving addictive substances, and the duration of this association may persist longer than for more general substance‐specific cues. Mobile technologies provide new opportunities for understanding these person‐specific risk factors and for providing individually tailored interventions.

Ferguson, Scott; Friedland, Daniel; Woodberry, Emma (2015): Smartphone technology: Gentle reminders of everyday tasks for those with prospective memory difficulties post-brain injury. In: Brain Injury 29 (5), S. 583–591. DOI: 10.3109/02699052.2014.1002109.

Background: Prospective memory is a common deficit following brain injury that can reduce an individuals’ ability to complete everyday tasks. The smartphone is a device that may compensate for these difficulties using the calendar’s prompting function. Reminders can be programmed remotely using email to phone synchronization. Objective: To explore whether smartphone reminders help people complete pre-identified tasks as compared to when reminders are not provided. Methods: An ABAB case series design compared reminder present vs. reminder absent phases with regards completion of pre-set tasks. Six participants aged 24–55 with Acquired Brain Injury (ABI) and five caregivers participated in the study. Both completed a series of questionnaires looking at the impact of the smartphone reminders on everyday memory functioning at pre, post and follow-up. A 3-month follow-up questionnaire assessed continued use of the system. Results: There was a significant improvement in task completion rates when smartphone reminders were provided. A thematic analysis identified that smartphone reminders improved independence, confidence in coping with memory difficulties and general mood. All participants were still using the system at 3-month follow-up. Conclusions: Smartphone reminders may provide a cost-effective, accessible and non-stigmatizing tool for participants to compensate for prospective memory difficulties.

Ferguson, Stuart G.; Frandsen, Mai; Dunbar, Michael S.; Shiffman, Saul (2015): Gender and stimulus control of smoking behavior. In: Nicotine & Tobacco Research 17 (4), S. 431–437. DOI: 10.1093/ntr/ntu195.

Introduction: Gender differences in smoking behavior have been proposed to account for poorer outcomes among women attempting to quit. Specifically, it has been suggested that women’s smoking behavior is less motivated by nicotine-seeking and more driven by environmental cues. To date, however, few real-world studies have examined the hypothesis that women’s smoking is under greater stimulus control. Methods: One hundred and ninety four daily smokers (men = 107; women = 87) completed 3 weeks of ecological momentary assessment (EMA) monitoring that provided data on real-world smoking behavior by reporting on situational contexts shown by previous research to influence smoking behavior (including social setting, cigarette availability, alcohol consumption, and mood). Results: Analyses of particular cues found few gender differences; however, men’s smoking increased to a greater extent compared with women’s when they were with others who were smoking. Idiographic analyses that allow individual subjects to have different directions of linkage to situational cues also were conducted to assess how predictable subjects’ smoking was from a range of contextual characteristics. Compared with women, men’s smoking was significantly more closely tied to food/alcohol consumption and tended to be more closely tied to social context. No other gender differences were found. Conclusions: EMA analyses suggest that men and women are similarly influenced by cues, including mood. Where there were gender differences, it was men rather than women whose smoking behavior was more influenced by cues. The data contradict the hypothesis that women’s smoking is more influenced by cues.

Franklin, Barry A.; Brinks, Jenna; Sacks, Roger; Trivax, Justin; Friedman, Harold (2015): Reduced Walking Speed and Distance as Harbingers of the Approaching Grim Reaper. In: Am J Cardiol 116 (2), S. 313–317. DOI: 10.1016/j.amjcard.2015.04.024.

Although treadmill exercise testing can provide an assessment of cardiorespiratory fitness, which serves as an independent prognostic indicator, numerous studies now suggest that usual gait speed, time, or distance covered during walk performance tests and weekly walking distance/time are powerful predictors of mortality and future cardiovascular events in selected patients. This review summarizes the relation between these variables and their association with cardiovascular and all-cause mortality, with specific reference to potential underlying mechanisms and implications for the clinician. Contemporary health care providers have escalating opportunities to promote lifestyle physical activity using pedometers, accelerometers, and smartphone-based health and wellness applications. In conclusion, fitness and/or ambulatory indexes should be considered a “vital sign” in middle-aged and older adults.

Franklin, Michael S.; Smallwood, Jonathan; Zedelius, Claire M.; Broadway, James M.; Schooler, Jonathan W. (2015): Unaware yet reliant on attention: Experience sampling reveals that mind-wandering impedes implicit learning. In: Psychonomic Bulletin & Review. DOI: 10.3758/s13423-015-0885-5.

Although implicit learning has been widely studied, controversy remains regarding its reliance on attentional resources. A central issue in this controversy is the question of how best to manipulate attention. The usual approach of comparing implicit learning in a serial reaction time (SRT) task under single- versus dual-task conditions is known to be problematic, because the secondary task may not only divert attention away from the primary task, but also interfere with the implicit-learning process itself. To address this confound, in the present study we used an experience-sampling instead of a dual-task approach. We assessed lapses of attention (mind-wandering) with experience-sampling thought probes during a standard implicit-learning SRT task. The results revealed a significant negative correlation between mind-wandering and implicit learning. Thus, greater task focus was associated with improved implicit sequence learning. This result suggests that, at least in the context of this SRT task, optimal implicit learning relies on attention.

Frost, Allison; Hoyt, Lindsay T.; Chung, Alissa Levy; Adam, Emma K. (2015):Daily life with depressive sy mptoms: Gender differences in adolescents’ everyday emotional experiences. In: J Adolesc 43, S. 132–141. DOI: 10.1016/j.adolescence.2015.06.001.

Depression is a prevalent and debilitating illness facing many adolescents, especially adolescent girls, whose risk for this disorder is approximately twice that of boys. Many studies have identified mechanisms that place girls at higher risk for depression during adolescence. Few, however, have examined differences in the everyday emotional experiences of boys and girls with varying levels of depressive symptoms. Using the Experience Sampling Method, this study investigated the roles of gender and depressive symptomatology in the emotional experiences of a community sample of youth (11-18 year-olds) from the Sloan 500 Family Study. Females with higher levels of depressive symptoms were more likely than females with fewer depressive symptoms and all males to experience strong negative emotions and to attribute the cause of these emotions to other people. These results suggest that emotional reactivity in interpersonal contexts is especially important to understand gender differences in the daily experience of depressive symptoms.

Gardner, Robert S.; Ascoli, Giorgio A. (2015): The natural frequency of human prospective memory increases with age. In: Psychology and Aging 30 (2), S. 209–219. DOI: 10.1037/a0038876.

Autobiographical memory (AM), the recollection of past experiences, and prospective memory (PM), the prospection of future events, are prominent components of subjective life, yet data on the frequencies of their occurrence are limited. Using experience sampling, we quantified the incidence of AM and PM in natural settings among various age groups. Individuals of all ages reported engaging in AM approximately 10% of the time. In contrast, whereas younger subjects recalled PMs as often as they recalled AMs, older subjects experienced PM twice as frequently. AM occurrence was positively correlated with PM occurrence, most strongly among younger individuals. AM and PM durations were also positively correlated and remarkably stable across age groups. Together, these data identify an age-associated shift in the temporal orientation of recollection and quantify the relationship between AM and PM. More broadly, this approach provides a quantitative foundation of AM and PM occurrence, a crucial yet largely unexplored dimension of recollection.

Garrison, Kathleen A.; Pal, Prasanta; Rojiani, Rahil; Dallery, Jesse; O’Malley, Stephanie S.; Brewer, Judson A. (2015): A randomized controlled trial of smartphone-based mindfulness training for smoking cessation: a study protocol. In: BMC Psychiatry 15, S. 83. DOI: 10.1186/s12888-015-0468-z.

BACKGROUND: Tobacco use is responsible for the death of about 1 in 10 individuals worldwide. Mindfulness training has shown preliminary efficacy as a behavioral treatment for smoking cessation. Recent advances in mobile health suggest advantages to smartphone-based smoking cessation treatment including smartphone-based mindfulness training. This study evaluates the efficacy of a smartphone app-based mindfulness training program for improving smoking cessation rates at 6-months follow-up. METHODS/DESIGN: A two-group parallel-randomized clinical trial with allocation concealment will be conducted. Group assignment will be concealed from study researchers through to follow-up. The study will be conducted by smartphone and online. Daily smokers who are interested in quitting smoking and own a smartphone (n = 140) will be recruited through study advertisements posted online. After completion of a baseline survey, participants will be allocated randomly to the control or intervention group. Participants in both groups will receive a 22-day smartphone-based treatment program for smoking. Participants in the intervention group will receive mobile mindfulness training plus experience sampling. Participants in the control group will receive experience sampling-only. The primary outcome measure will be one-week point prevalence abstinence from smoking (at 6-months follow-up) assessed using carbon monoxide breath monitoring, which will be validated through smartphone-based video chat. DISCUSSION: This is the first intervention study to evaluate smartphone-based delivery of mindfulness training for smoking cessation. Such an intervention may provide treatment in-hand, in real-world contexts, to help individuals quit smoking. TRIAL REGISTRATION: Clinicaltrials.gov NCT02134509 . Registered 7 May 2014.

Gerpott, Torsten J.; Ahmadi, Nima (2015): Determinants of willingness to look for separate international roaming services—An empirical study of mobile communication customers in Germany. In: International Journal of Information Management 35 (2), S. 192–203. DOI: 10.1016/j.ijinfomgt.2014.11.004.

International roaming (IR) makes it possible to conveniently use mobile communication services (MCS) such as voice calling, text messaging and Internet access abroad without the hassle to switch providers, devices or SIM cards. In order to support a competitive intra-European Union (EU) market for IR services, consumers were enabled to buy IR services separate from their existing domestic MCS as of July 2014. Therefore, an understanding of determinants of residential customers’ willingness to look for separate IR services is of interest both for regulators and providers. Based on a review of three theoretical lenses (innovation adoption, service provider switching, consumer information search) the present study develops nine hypotheses on the level and on determinants of consumers’ willingness to look for separate IR services. The hypotheses are tested in a sample of 510 German-speaking MCS users. PLS analysis reveals that the constructs associated most strongly with the willingness criterion are IR price knowledge, expected risks of separated IR services (e.g., low savings, inaccurate bills) and expected ease of switching to unbundled IR offerings. Implications of the findings are reflected for the theoretical framings, regulators, firms entering the market for unbundled IR services and established mobile network operators defending their IR business.

Gevonden, M. J.; Myin-Germeys, I.; van den Brink, W.; van Os, J.; Selten, J. P.; Booij, J. (2015): Psychotic reactions to daily life stress and dopamine function in people with severe hearing impairment. In: Psychological Medicine 45 (8), S. 1665–1674. DOI: 10.1017/S0033291714002797.

Background: Minor stresses measured in daily life have repeatedly been associated with increased momentary psychotic experiences, both in individuals with psychotic disorders and in persons who are genetically at an increased risk for these disorders. Severe hearing impairment (SHI) is an environmental risk factor for psychotic disorder, possibly due to the experience of social exclusion. The aim of the current study is to investigate whether people with SHI exhibit higher levels of psychotic reactivity to social stressors in daily life than normal-hearing controls and whether this reactivity is associated with decreased baseline dopamine (DA) D2/3 receptor availability and/or elevated DA release following a dexamphetamine challenge. Method: We conducted an experience sampling study in 15 young adults with SHI and 19 matched normal-hearing controls who had previously participated in a single photon emission computed tomography study measuring DA D2/3 receptor availability and DA release in response to dexamphetamine. Results: The association between social stress and momentary psychotic experiences in daily life was stronger among SHI participants than among normal-hearing controls. Interactions between social stress and baseline striatal DA D2/3 receptor availability or DA release were not significant in multilevel models of momentary psychotic experiences including age, sex and tobacco use. Conclusions: While both elevated striatal DA release and elevated psychotic stress reactivity have been found in the same population defined by an environmental risk factor, SHI, their inter-relationship cannot be established. Further research is warranted to clarify the association between biological and psychological endophenotypes and psychosis risk.

Goldschmidt, Andrea B.; Accurso, Erin C.; Schreiber‐Gregory, Deanna N.; Crosby, Ross D.; Cao, Li; Engel, Scott G. et al. (2015): Behavioral, emotional, and situational context of purging episodes in anorexia nervosa. In: International Journal of Eating Disorders 48 (3), S. 341–344. DOI: 10.1002/eat.22381.

Objective: The current study examined behavioral, emotional, and situational factors involved in purging among women with anorexia nervosa (AN). Method: Women with AN (n = 118) completed a two‐week ecological momentary assessment protocol involving daily reports of eating disorder behaviors, mood, and stressful events. Generalized estimating equations examined the likelihood and context of purging following eating episodes involving both overeating and loss of control (binge eating; BE); loss of control only (LOC); overeating only (OE); and neither loss of control nor overeating (non‐pathological eating; NE). Results: Relative to NE, purging was more likely to occur following BE, LOC, and OE (Wald chi‐square = 18.05; p < .001). BE was more strongly associated with subsequent purging than LOC but not OE; the latter two did not differ from one another. Negative affect predicted purging following NE (Wald chi‐square = 7.71; p = .005). Discussion: Binge eating involving large amounts of food was the strongest predictor of purging in AN, which challenges the notion that loss of control is the most salient aspect of experiencing distress in bulimia nervosa and BE disorder. Parallel to findings from the BE literature, negative affect strongly predicted purging following NE. Further research should clarify the function and triggers of purging in AN.

Goldschmidt, Andrea B.; Accurso, Erin C.; Schreiber‐Gregory, Deanna N.; Crosby, Ross D.; Cao, Li; Engel, Scott G. et al. (2015): Behavioral, emotional, and situational context of purging episodes in anorexia nervosa. In: International Journal of Eating Disorders 48 (3), S. 341–344. DOI: 10.1002/eat.22381.

Objective: The current study examined behavioral, emotional, and situational factors involved in purging among women with anorexia nervosa (AN). Method: Women with AN (n = 118) completed a two‐week ecological momentary assessment protocol involving daily reports of eating disorder behaviors, mood, and stressful events. Generalized estimating equations examined the likelihood and context of purging following eating episodes involving both overeating and loss of control (binge eating; BE); loss of control only (LOC); overeating only (OE); and neither loss of control nor overeating (non‐pathological eating; NE). Results: Relative to NE, purging was more likely to occur following BE, LOC, and OE (Wald chi‐square = 18.05; p < .001). BE was more strongly associated with subsequent purging than LOC but not OE; the latter two did not differ from one another. Negative affect predicted purging following NE (Wald chi‐square = 7.71; p = .005). Discussion: Binge eating involving large amounts of food was the strongest predictor of purging in AN, which challenges the notion that loss of control is the most salient aspect of experiencing distress in bulimia nervosa and BE disorder. Parallel to findings from the BE literature, negative affect strongly predicted purging following NE. Further research should clarify the function and triggers of purging in AN.

Gonzalez, Vivian M.; Dulin, Patrick L. (2015): Comparison of a smartphone app for alcohol use disorders with an Internet-based intervention plus bibliotherapy: A pilot study. In: Journal of Consulting and Clinical Psychology 83 (2), S. 335–345. DOI: 10.1037/a0038620.

Objective: To date, no research has evaluated the efficacy of a stand-alone, smartphone-based intervention for individuals with an alcohol use disorder. The current pilot study evaluated the short-term outcomes of a smartphone-based intervention for alcohol use disorders compared with an Internet-based brief motivational intervention plus bibliotherapy. Method: Adults (18 to 45 years old) with an alcohol use disorder received either the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A; n = 28), a smartphone-based intervention, or the online Drinker’s Check-up plus bibliotherapy (DCU + bib; n = 26). These groups were compared using the Timeline Followback interview for percent days abstinent (PDA), percent heavy drinking days (PHDD), and drinks per week (DPW) from baseline to 6 weeks after the introduction of the interventions. Results: Multilevel models revealed that the LBMI-A resulted in a significant increase in PDA over the course of the study, whereas the DCU + bib did not. Effect sizes for change from baseline for PDA suggest that the DCU + bib resulted in moderate a decrease, whereas the LBMI-A resulted in a large increase in PDA. Both interventions resulted in significant decreases in PHDD and DPW. The LBMI-A produced larger reductions in the first 3 to 4 weeks after the intervention was introduced than the DCU + bib. On weeks with greater LBMI-A usage, participants reported less DPW and PHDD. Conclusions: Both interventions resulted in significant decreases in alcohol use over the 6-week trial, which is promising for stand-alone technology-based intervention systems aimed at individuals with an alcohol use disorder.

Grimm, Carsten; Kemp, Simon; Jose, Paul E. (2015): Orientations to happiness and the experience of everyday activities. In: The Journal of Positive Psychology 10 (3), S. 207–218. DOI: 10.1080/17439760.2014.941382.

The orientation to happiness framework proposes that individuals seek well-being through three behavioral orientations: Pleasure, meaning, and engagement. We investigated how orientations to happiness (OTH) influenced the pursuit and experience of daily activities using experience sampling methods. One hundred and seventy three people responded to three text messages per day for seven days asking how they felt about their current activity. Most participants did not report a dominant orientation to happiness, and the highest rated orientation receiving did not predict which daily activities participants engaged in most. However, trait orientation to happiness related to how activities were experienced. Individuals scoring highly on all three orientations rated their activities highly on momentary pleasure, meaning, engagement, and happiness. Overall, it appears more important for daily well-being to have a balanced and strong portfolio of the three OTH than to have any one particularly dominant orientation.

Grund, Axel; Schmid, Sebastian; Fries, Stefan (2015): Studying against your will: Motivational interference in action. In: Contemporary Educational Psychology 41, S. 209–217. DOI: 10.1016/j.cedpsych.2015.03.003.

Motivational interference refers to affective, cognitive, and behavioral impairments during a focal activity due to conflicting action tendencies. In the present study, we focused on antecedents and domain-specific consequences of motivational interference during everyday study activities using an experience sampling approach. Fifty-eight university students provided real-time reports on their daily studying activities (N = 672) over the course of one week. They reported on their momentary affect, whether they experienced motivational conflict during their study activities, and, if so, indicated when this feeling emerged. After the experience sampling period, they reported on their academic and social adaptation as well as their study satisfaction, and rated their relative performance. Compared with non-conflicted studying activities, we found considerably lower positive affect during conflicted studying. Conflicts that existed before the initiation of the study activity, and conflicts that emerged during studying, yielded affective impairments. As expected, aggregated conflict experiences negatively predicted measures of academic functioning, but not students’ social adaptation. The discussion focuses on motivational antecedents of interference effects during self-regulated learning.

Guillory, Jamie; Chang, Pamara; Henderson, Charles R. Jr.; Shengelia, Rouzi; Lama, Sonam; Warmington, Marcus et al. (2015): Piloting a text message-based social support intervention for patients with chronic pain: Establishing feasibility and preliminary efficacy. In: The Clinical Journal of Pain 31 (6), S. 548–556. DOI: 10.1097/AJP.0000000000000193.

Objectives: To examine preliminarily the effectiveness of a short message service (SMS) text message–based social support intervention for reducing daily pain and pain interference levels, improving affect and perceptions of social support in patients with chronic noncancer pain, and exploring the feasibility of a novel mobile application to track perceptions of pain and pain interference. Materials and Methods: Participants (17 men, 51 women) from 2 pain clinics in New York City downloaded a pain tracking application (App) on their Smartphone and used it to record twice-daily pain, pain interference, and affect scores over the 4-week study period. Participants were randomly assigned to receive standard care (control) or standard care along with receipt of twice-daily supportive SMS text messages delivered during the second and third week of the study (intervention). Demographic and clinical data were obtained at baseline, and social support measures were administered at baseline and at 4 weeks. Statistical analysis was carried out using general linear mixed models, taking into account variances associated with time of assessments and with patients. Results: The social support intervention reduced perceptions of pain and pain interference and improved positive affect for chronic noncancer pain patients assigned to the intervention condition in comparison with controls. Participants completed approximately 80% of the daily measurements requested. Discussion: These findings establish the feasibility of collecting daily pain data using a mobile tracking App and provide significant implications and insight into a nuanced approach to reducing the daily experience of pain through mobile technology, especially because of its accessibility.

Guinness, Robert E. (2015): Beyond where to how: a machine learning approach for sensing mobility contexts using smartphone sensors. In: Sensors (Basel) 15 (5), S. 9962–9985. DOI: 10.3390/s150509962.

This paper presents the results of research on the use of smartphone sensors (namely, GPS and accelerometers), geospatial information (points of interest, such as bus stops and train stations) and machine learning (ML) to sense mobility contexts. Our goal is to develop techniques to continuously and automatically detect a smartphone user’s mobility activities, including walking, running, driving and using a bus or train, in real-time or near-real-time (<5 s). We investigated a wide range of supervised learning techniques for classification, including decision trees (DT), support vector machines (SVM), naive Bayes classifiers (NB), Bayesian networks (BN), logistic regression (LR), artificial neural networks (ANN) and several instance-based classifiers (KStar, LWLand IBk). Applying ten-fold cross-validation, the best performers in terms of correct classification rate (i.e., recall) were DT (96.5%), BN (90.9%), LWL (95.5%) and KStar (95.6%). In particular, the DT-algorithm RandomForest exhibited the best overall performance. After a feature selection process for a subset of algorithms, the performance was improved slightly. Furthermore, after tuning the parameters of RandomForest, performance improved to above 97.5%. Lastly, we measured the computational complexity of the classifiers, in terms of central processing unit (CPU) time needed for classification, to provide a rough comparison between the algorithms in terms of battery usage requirements. As a result, the classifiers can be ranked from lowest to highest complexity (i.e., computational cost) as follows: SVM, ANN, LR, BN, DT, NB, IBk, LWL and KStar. The instance-based classifiers take considerably more computational time than the non-instance-based classifiers, whereas the slowest non-instance-based classifier (NB) required about five-times the amount of CPU time as the fastest classifier (SVM). The above results suggest that DT algorithms are excellent candidates for detecting mobility contexts in smartphones, both in terms of performance and computational complexity.

Gummer, Ricarda; Giel, Katrin Elisabeth; Schag, Kathrin; Resmark, Gaby; Junne, Florian Philipp; Becker, Sandra et al. (2015): High Levels of Physical Activity in Anorexia Nervosa: A Systematic Review. In: Eur Eat Disord Rev. DOI: 10.1002/erv.2377.

High level physical activity is a frequent symptom in patients with anorexia nervosa (AN), influencing the development, maintenance, complications, treatment success, relapse rate and severity of the disease. Accelerometry is assumed to be an objective method to assess physical activity (PA) in AN. We aimed to review objectively measured levels of PA in AN and to give an overview for clinical practice and future research. Data were searched in PubMed and PsychINFO until April 2015 following the preferred reporting items for systematic reviews and meta-analyses statement. Twenty studies fulfilled the inclusion criteria. A notable heterogeneity of measurements, outcomes, participants and settings was found. Overall, HLPA is not adressed enough by current evidence. A common valid terminology of HLPA is not available, and accurate criteria of different levels of PA must be defined to create comparability of future studies. Further objective PA assessments are needed to improve treatment outcome and relapse rate. Copyright (c) 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Haedt-Matt, Alissa A.; Keel, Pamela K. (2015): Affect regulation and purging: An ecological momentary assessment study in purging disorder. In: Journal of Abnormal Psychology 124 (2), S. 399–411. DOI: 10.1037/a0038815.

Research suggests that affect may play an important role in the propensity to purge among women with purging disorder (PD). However, prior work has been constrained to cross-sectional or laboratory designs, which impact temporal interpretations and ecological validity. This study examined negative affect (NA) and positive affect (PA) in triggering and maintaining purging in PD using ecological momentary assessment. Women with PD (N = 24) made multiple daily ratings of affect and behavior for 2 weeks. Multilevel models examined associations between affect and purging at different levels of analysis, including a novel analytic approach to address the specificity of changes in affect relative to purging behavior by comparing trajectories of change on purge versus nonpurge days. For trajectories of affect over time, NA increased before purging and decreased following purging on purge days; however, only the decrease in NA following purging was significantly different from the trajectory of NA on nonpurge days. Conversely, PA failed to increase before purging on purge days compared with a matched time-point on nonpurge days. These findings suggest unique roles of PA in triggering and NA in maintaining purging in PD and support models in which purging functions to regulate affect. For comparisons of ratings before and after purging, NA increased and PA decreased after purging, highlighting how different analytic strategies produce different findings requiring integration into affect regulation models. These data provide insight into why women with PD purge after consuming normal amounts of food, a crucial first step for developing effective interventions.

Hameed, M. A.; Tebbit, L.; Jacques, N.; Thomas, M.; Dasgupta, I. (2015): Non-adherence to antihypertensive medication is very common among resistant hypertensives: results of a directly observed therapy clinic. In: J Hum Hypertens. DOI: 10.1038/jhh.2015.38.

Resistant hypertension is common among the hypertensive population with reported prevalence of 12 to 15%. These patients have a higher cardiovascular risk and consequently a poorer cardiovascular prognosis. Suboptimal adherence with antihypertensive medication is a common contributing factor in apparent treatment-resistant hypertension. Patients were observed taking their medications under direct supervision at our directly observed therapy (DOT) clinic. At the DOT clinic visit, patients were fitted with a 24-h ambulatory blood pressure (ABP) monitor and each drug, at currently prescribed dose, was administered by a nurse; at an hourly interval and patient observed for 7 h. ABP readings between pre and post DOT clinic were compared. Fifty out of 56 patients had complete data on the ABP. Twenty four were female and the mean (s.d.) age was 62.0 (11.0) years. On the basis of the study methods that differentiated patients according to their BP response during the DOT clinic, twenty-five (50.0%) patients were deemed to be truly resistant (24-h ambulatory systolic blood pressure (SBP) fall <5 mm Hg) and the remaining 25 were deemed to have clinically significant non-adherence (24-h ambulatory SBP fall 5 mm Hg) to prescribed therapy. In non-adherent patients, the mean 24-h ambulatory BP drop observed was 19.5/9.4 mm Hg (P<0.001 for both). Our results suggest that non-adherence is very common among patients considered to have apparent treatment-resistant hypertension. DOT clinic can be an effective method of identifying the truly resistant hypertensive patients.Journal of Human Hypertension advance online publication, 7 May 2015; doi:10.1038/jhh.2015.38.

Hammonds, Tracy; Rickert, Krista; Goldstein, Carly; Gathright, Emily; Gilmore, Sarah; Derflinger, Bethany et al. (2015): Adherence to antidepressant medications: A randomized controlled trial of medication reminding in college students. In: Journal of American College Health 63 (3), S. 204–208. DOI: 10.1080/07448481.2014.975716.

Objectives: To determine if medication reminding via smartphone app increases adherence to antidepressant medications in college students. Participants: College students (N = 57) enrolled at a state-funded institution who had a current prescription for an antidepressant and regularly used a smartphone device. Methods: Participants were randomized to either a reminder group or a control group. Both groups were asked to complete a survey and undergo a manual pill count at the beginning of the study and 30 days later. Results: There was a strong trend suggesting that the use of a medication reminder app was beneficial for adherence to antidepressant medication regimens. Factors influencing medication adherence in college students included health beliefs, use of illicit drugs, and type of professional care received. Conclusions: Use of a medication reminder may increase adherence to antidepressant medications in college students.

Hartmann, Jessica A.; Wichers, Marieke; Menne-Lothmann, Claudia; Kramer, Ingrid; Viechtbauer, Wolfgang; Peeters, Frenk et al. (2015): Experience sampling-based personalized feedback and positive affect: a randomized controlled trial in depressed patients. In: PLoS One 10 (6), S. e0128095. DOI: 10.1371/journal.pone.0128095.

OBJECTIVES: Positive affect (PA) plays a crucial role in the development, course, and recovery of depression. Recently, we showed that a therapeutic application of the experience sampling method (ESM), consisting of feedback focusing on PA in daily life, was associated with a decrease in depressive symptoms. The present study investigated whether the experience of PA increased during the course of this intervention. DESIGN: Multicentre parallel randomized controlled trial. An electronic random sequence generator was used to allocate treatments. SETTINGS: University, two local mental health care institutions, one local hospital. PARTICIPANTS: 102 pharmacologically treated outpatients with a DSM-IV diagnosis of major depressive disorder, randomized over three treatment arms. INTERVENTION: Six weeks of ESM self-monitoring combined with weekly PA-focused feedback sessions (experimental group); six weeks of ESM self-monitoring combined with six weekly sessions without feedback (pseudo-experimental group); or treatment as usual (control group). MAIN OUTCOME: The interaction between treatment allocation and time in predicting positive and negative affect (NA) was investigated in multilevel regression models. RESULTS: 102 patients were randomized (mean age 48.0, SD 10.2) of which 81 finished the entire study protocol. All 102 patients were included in the analyses. The experimental group did not show a significant larger increase in momentary PA during or shortly after the intervention compared to the pseudo-experimental or control groups (chi2 (2) =0.33, p=.846). The pseudo-experimental group showed a larger decrease in NA compared to the control group (chi2 (1) =6.29, p=.012). CONCLUSION: PA-focused feedback did not significantly impact daily life PA during or shortly after the intervention. As the previously reported reduction in depressive symptoms associated with the feedback unveiled itself only after weeks, it is conceivable that the effects on daily life PA also evolve slowly and therefore were not captured by the experience sampling procedure immediately after treatment. TRIAL REGISTRATION: Trialregister.nl/trialreg/index.asp. NTR1974.

Hekler, Eric B.; Buman, Matthew P.; Grieco, Lauren; Rosenberger, Mary; Winter, Sandra J.; Haskell, William; King, Abby C. (2015): Validation of Physical Activity Tracking via Android Smartphones Compared to ActiGraph Accelerometer: Laboratory-Based and Free-Living Validation Studies. In: JMIR Mhealth Uhealth 3 (2), S. e36. DOI: 10.2196/mhealth.3505.

BACKGROUND: There is increasing interest in using smartphones as stand-alone physical activity monitors via their built-in accelerometers, but there is presently limited data on the validity of this approach. OBJECTIVE: The purpose of this work was to determine the validity and reliability of 3 Android smartphones for measuring physical activity among midlife and older adults. METHODS: A laboratory (study 1) and a free-living (study 2) protocol were conducted. In study 1, individuals engaged in prescribed activities including sedentary (eg, sitting), light (sweeping), moderate (eg, walking 3 mph on a treadmill), and vigorous (eg, jogging 5 mph on a treadmill) activity over a 2-hour period wearing both an ActiGraph and 3 Android smartphones (ie, HTC MyTouch, Google Nexus One, and Motorola Cliq). In the free-living study, individuals engaged in usual daily activities over 7 days while wearing an Android smartphone (Google Nexus One) and an ActiGraph. RESULTS: Study 1 included 15 participants (age: mean 55.5, SD 6.6 years; women: 56%, 8/15). Correlations between the ActiGraph and the 3 phones were strong to very strong (rho=.77-.82). Further, after excluding bicycling and standing, cut-point derived classifications of activities yielded a high percentage of activities classified correctly according to intensity level (eg, 78%-91% by phone) that were similar to the ActiGraph’s percent correctly classified (ie, 91%). Study 2 included 23 participants (age: mean 57.0, SD 6.4 years; women: 74%, 17/23). Within the free-living context, results suggested a moderate correlation (ie, rho=.59, P<.001) between the raw ActiGraph counts/minute and the phone’s raw counts/minute and a strong correlation on minutes of moderate-to-vigorous physical activity (MVPA; ie, rho=.67, P<.001). Results from Bland-Altman plots suggested close mean absolute estimates of sedentary (mean difference=-26 min/day of sedentary behavior) and MVPA (mean difference=-1.3 min/day of MVPA) although there was large variation. CONCLUSIONS: Overall, results suggest that an Android smartphone can provide comparable estimates of physical activity to an ActiGraph in both a laboratory-based and free-living context for estimating sedentary and MVPA and that different Android smartphones may reliably confer similar estimates.

Hidalgo-Mazzei, Diego; Mateu, Ainoa; Reinares, Maria; Undurraga, Juan; Bonnin, Caterina del Mar; Sanchez-Moreno, Jose et al. (2015): Self-monitoring and psychoeducation in bipolar patients with a smart-phone application (SIMPLe) project: design, development and studies protocols. In: BMC Psychiatry 15, S. 52. DOI: 10.1186/s12888-015-0437-6.

BACKGROUND: New technologies have recently been used for monitoring signs and symptoms of mental health illnesses and particularly have been tested to improve the outcomes in bipolar disorders. Web-based psychoeducational programs for bipolar disorders have also been implemented, yet to our knowledge, none of them have integrated both approaches in one single intervention. The aim of this project is to develop and validate a smartphone application to monitor symptoms and signs and empower the self-management of bipolar disorder, offering customized embedded psychoeducation contents, in order to identify early symptoms and prevent relapses and hospitalizations. METHODS/DESIGN: The project will be carried out in three complementary phases, which will include a feasibility study (first phase), a qualitative study (second phase) and a randomized controlled trial (third phase) comparing the smartphone application (SIMPLe) on top of treatment as usual with treatment as usual alone. During the first phase, feasibility and satisfaction will be assessed with the application usage log data and with an electronic survey. Focus groups will be conducted and technical improvements will be incorporated at the second phase. Finally, at the third phase, survival analysis with multivariate data analysis will be performed and relationships between socio-demographic, clinical variables and assessments scores with relapses in each group will be explored. DISCUSSION: This project could result in a highly available, user-friendly and not costly monitoring and psychoeducational intervention that could improve the outcome of people suffering from bipolar disorders in a practical and secure way. TRIAL REGISTRATION: Clinical Trials.gov: NCT02258711 (October 2014).

Higgins, John P. (2015): Smartphone Applications for Patients’ Health & Fitness. In: Am J Med. DOI: 10.1016/j.amjmed.2015.05.038.

Healthcare providers are often looking for ways to objectively monitor and improve their patients’ health and fitness, especially in between patient visits. Some insurance companies are using app data as incentives to improve health and lower premiums. As more and more people start to use smartphones, they may provide a tool to help improve a patient’s health and fitness. Specifically, fitness applications or ‘apps’ on smartphones are programs that use data collected from a smartphone’s inbuilt tools such as Global Positioning System (GPS) tracking, accelerometer, microphone, speaker, and camera to measure health and fitness parameters. The apps then analyze this data and summarize it, as well as devise individualized plans based on users’ goals, provide frequent feedback, personalized coaching, and additional motivation by allowing milestones to be shared on social media. This paper introduces evidence that apps can better help patients reach their health and fitness goals. It then discusses what features to look for in an app, followed by an overview of popular health and fitness apps. Lastly patient scenarios with app recommendations, limitations of apps, and future research are discussed.

Hoeppner, Bettina B.; Hoeppner, Susanne S.; Seaboyer, Lourah; Schick, Melissa R.; Wu, Gwyneth W Y; Bergman, Brandon G.; Kelly, John F. (2015): How Smart are Smartphone Apps for Smoking Cessation? A Content Analysis. In: Nicotine Tob Res. DOI: 10.1093/ntr/ntv117.

INTRODUCTION: Smartphone technology is ideally suited to provide tailored smoking cessation support, yet it is unclear to what extent currently existing smartphone “apps” use tailoring, and if tailoring is related to app popularity and user-rated quality. METHODS: We conducted a content analysis of Android smoking cessation apps (n = 225), downloaded between October 1, 2013 to May 31, 2014. We recorded app popularity (>10 000 downloads) and user-rated quality (number of stars) from Google Play, and coded the existence of tailoring features in the apps within the context of using the 5As (“ask,” “advise,” “assess,” “assist,” and “arrange follow-up”), as recommended by national clinical practice guidelines. RESULTS: Apps largely provided simplistic tools (eg, calculators, trackers), and used tailoring sparingly: on average, apps addressed 2.1+/-0.9 of the 5As and used tailoring for 0.7+/-0.9 of the 5As. Tailoring was positively related to app popularity and user-rated quality: apps that used two-way interactions (odds ratio [OR] = 5.56 [2.45-12.62]), proactive alerts (OR = 3.80 [1.54-9.38]), responsiveness to quit status (OR = 5.28 [2.18-12.79]), addressed more of the 5As (OR = 1.53 [1.10-2.14]), used tailoring for more As (OR = 1.67 [1.21-2.30]), and/or used more ways of tailoring 5As content (OR = 1.35 [1.13-1.62]) were more likely to be frequently downloaded. Higher star ratings were associated with a higher number of 5As addressed (b = 0.16 [0.03-0.30]), a higher number of 5As with any level of tailoring (b = 0.14 [0.01-0.27]), and a higher number of ways of tailoring 5As content (b = 0.08 [0.002-0.15]). CONCLUSIONS: Publically available smartphone smoking cessation apps are not particularly “smart”: they commonly fall short of providing tailored feedback, despite users’ preference for these features.

Hofmann, Wilhelm; Finkel, Eli J.; Fitzsimons, Grainne M. (2015): Close Relationships and Self-Regulation: How Relationship Satisfaction Facilitates Momentary Goal Pursuit. In: J Pers Soc Psychol. DOI: 10.1037/pspi0000020.

In the new millennium, scholars have built a robust intersection between close-relationships research and self-regulation research. However, virtually no work has investigated how the most basic and broad indicator of relationship quality, relationship satisfaction, affects self-regulation and vice versa. In the present research, we show that higher relationship satisfaction promotes a motivational mind-set that is conducive for effective self-regulation, and thus for goal progress and performance. In Study 1-a large-scale, intensive experience sampling project of 115 couples (total N = 230)-we closely tracked fluctuations in state relationship satisfaction (SRS) and 4 parameters of effective self-regulation according to our conceptual model. Dyadic process analyses showed that individuals experiencing higher SRS than they typically do exhibited higher levels of (a) perceived control, (b) goal focus, (c) perceived partner support, and (d) positive affect during goal pursuit than they typically exhibit. Together, these 4 self-regulation-relevant variables translated into higher rates of daily progress on specific, idiographic goals. In Study 2 (N = 195), we employed a novel experimental manipulation of SRS, replicating the link between SRS and parameters of effective self-regulation. Taken together, these findings suggest that momentary increases in relationship satisfaction may benefit everyday goal pursuit through a combination of cognitive and affective mechanisms, thus further integrating relationship research with social-cognitive research on goal pursuit.

Hofmann, Wilhelm; Patel, Paresh V. (2015): SurveySignal: A convenient solution for experience sampling research using participants’ own smartphones. In: Social Science Computer Review 33 (2), S. 235–253. DOI: 10.1177/0894439314525117.

Experience sampling or ecological momentary assessment offers unique insights into how people think, feel, and behave in their natural environments. Because the method is able to capture situational variation as it happens in “real time,” experience sampling has become an increasingly popular method in social and personality, psychology, and beyond. With the ubiquity of smartphone ownership and the recent technical advances, conducting experience sampling studies on participants’ own devices has become increasingly easy to do. Here, we present one reliable, user-friendly, highly customizable, and cost-effective solution. The web-based application, SurveySignal, integrates the idea of using short message service (SMS) messages as signals and reminders, according to fixed or random schedules and of linking these signals to mobile surveys designed with common online survey software. We describe the method and customizable parameters and then present evaluation results from nine social–psychological studies conducted with SurveySignal (overall N = 1,852). Mean response rates averaged 77% and the median response delay to signals was 8 min. An experimental manipulation of the reminder signal in one study showed that installing a reminder SMS led to a 10% increase in response rates. Next to advantages and limitations of the SMS approach, we discuss how ecologically valid research methods such as smartphone experience sampling can enrich psychological research.

Hogenelst, Koen; Schoevers, Robert A.; aan het Rot, Marije (2015): Studying the neurobiology of human social interaction: Making the case for ecological validity. In: Social Neuroscience 10 (3), S. 219–229. DOI: 10.1080/17470919.2014.994786.

With this commentary we make the case for an increased focus on the ecological validity of the measures used to assess aspects of human social functioning. Impairments in social functioning are seen in many types of psychopathology, negatively affecting the lives of psychiatric patients and those around them. Yet the neurobiology underlying abnormal social interaction remains unclear. As an example of human social neuroscience research with relevance to biological psychiatry and clinical psychopharmacology, this commentary discusses published experimental studies involving manipulation of the human brain serotonin system that included assessments of social behavior. To date, these studies have mostly been laboratory-based and included computer tasks, observations by others, or single-administration self-report measures. Most laboratory measures used so far inform about the role of serotonin in aspects of social interaction, but the relevance for real-life interaction is often unclear. Few studies have used naturalistic assessments in real life. We suggest several laboratory methods with high ecological validity as well as ecological momentary assessment, which involves intensive repeated measures in naturalistic settings. In sum, this commentary intends to stimulate experimental research on the neurobiology of human social interaction as it occurs in real life.

Hongu, Nobuko; Pope, Benjamin T.; Bilgic, Pelin; Orr, Barron J.; Suzuki, Asuka; Kim, Angela Sarah et al. (2015): Usability of a smartphone food picture app for assisting 24-hour dietary recall: a pilot study. In: Nutr Res Pract 9 (2), S. 207–212. DOI: 10.4162/nrp.2015.9.2.207.

BACKGROUND/OBJECTIVES: The Recaller app was developed to help individuals record their food intakes. This pilot study evaluated the usability of this new food picture application (app), which operates on a smartphone with an embedded camera and Internet capability. SUBJECTS/METHODS: Adults aged 19 to 28 years (23 males and 22 females) were assigned to use the Recaller app on six designated, nonconsecutive days in order to capture an image of each meal and snack before and after eating. The images were automatically time-stamped and uploaded by the app to the Recaller website. A trained nutritionist administered a 24-hour dietary recall interview 1 day after food images were taken. Participants’ opinions of the Recaller app and its usability were determined by a follow-up survey. As an evaluation indicator of usability, the number of images taken was analyzed and multivariate Poisson regression used to model the factors determining the number of images sent. RESULTS: A total of 3,315 food images were uploaded throughout the study period. The median number of images taken per day was nine for males and 13 for females. The survey showed that the Recaller app was easy to use, and 50% of the participants would consider using the app daily. Predictors of a higher number of images were as follows: greater interval (hours) between the first and last food images sent, weekend, and female. CONCLUSIONS: The results of this pilot study provide valuable information for understanding the usability of the Recaller smartphone food picture app as well as other similarly designed apps. This study provides a model for assisting nutrition educators in their collection of food intake information by using tools available on smartphones. This innovative approach has the potential to improve recall of foods eaten and monitoring of dietary intake in nutritional studies.

Horne, Malcolm K.; McGregor, Sarah; Bergquist, Filip (2015): An objective fluctuation score for Parkinson’s disease. In: PLoS One 10 (4), S. e0124522. DOI: 10.1371/journal.pone.0124522.

INTRODUCTION: Establishing the presence and severity of fluctuations is important in managing Parkinson’s Disease yet there is no reliable, objective means of doing this. In this study we have evaluated a Fluctuation Score derived from variations in dyskinesia and bradykinesia scores produced by an accelerometry based system. METHODS: The Fluctuation Score was produced by summing the interquartile range of bradykinesia scores and dyskinesia scores produced every 2 minutes between 0900-1800 for at least 6 days by the accelerometry based system and expressing it as an algorithm. RESULTS: This Score could distinguish between fluctuating and non-fluctuating patients with high sensitivity and selectivity and was significant lower following activation of deep brain stimulators. The scores following deep brain stimulation lay in a band just above the score separating fluctuators from non-fluctuators, suggesting a range representing adequate motor control. When compared with control subjects the score of newly diagnosed patients show a loss of fluctuation with onset of PD. The score was calculated in subjects whose duration of disease was known and this showed that newly diagnosed patients soon develop higher scores which either fall under or within the range representing adequate motor control or instead go on to develop more severe fluctuations. CONCLUSION: The Fluctuation Score described here promises to be a useful tool for identifying patients whose fluctuations are progressing and may require therapeutic changes. It also shows promise as a useful research tool. Further studies are required to more accurately identify therapeutic targets and ranges.

Houben, Marlies; Vansteelandt, Kristof; Claes, Laurence; Sienaert, Pascal; Berens, Ann; Sleuwaegen, Ellen; Kuppens, Peter (2015): Emotional Switching in Borderline Personality Disorder: A Daily Life Study. In: Personal Disord. DOI: 10.1037/per0000126.

Despite large efforts to understand emotional instability in borderline personality disorder (BPD), it is still unclear exactly how this is manifested in the daily lives of people suffering from the disorder. Building on theoretical and clinical observations of BPD, we propose that the emotional instability in BPD particularly consists of the occurrence of strong changes between positive and negative emotional states from 1 moment to the next, labeled emotional switching. We tested this proposal by means of an experience sampling study in which 30 BPD patients and 28 healthy controls reported in their daily lives the level of pleasantness/unpleasantness of their emotional states 10 times a day for 8 consecutive days using handheld palmtops. Results showed that although BPD patients did not differ from healthy controls regarding their overall tendency to switch from a positive to a negative emotional state or vice versa, the size of such changes between positive and negative states was found to be significantly larger in BPD patients. In contrast, the magnitude of emotional changes that remained within the negative emotional range or positive emotional range was not particularly larger for BPD patients compared with healthy participants. These findings imply that the emotional instability in BPD is particularly characterized by larger changes from positive to negative states and vice versa, rather than overall larger changes in intensity, providing insight into possible processes underlying emotion dysfunction in BPD.

Houtveen, Jan H.; Lipovsky, Myriam M.; Kool, Marloes; Sorbi, Marjolijn; Buhring, Martina E F; van Broeckhuysen-Kloth, Saskia (2015): The day-to-day concurrence of bodily complaints and affect in patients with severe somatoform disorder. In: Scand J Psychol. DOI: 10.1111/sjop.12228.

Based on the concept of somatization, psychological distress can be experienced as symptoms of physical illness. This suggests a close-fitting intra-individual association between bodily complaints and mood in patients with somatoform disorder (SFD). The contemporaneous day-to-day complaints-mood association was investigated in patients with severe chronic SFD using an ecological momentary assessment (EMA) design. Eleven patients, who had recently received specialized tertiary care treatment for severe chronic SFD, kept an online electronic diary for four consecutive weeks. They were prompted at intervals throughout the day to complete questions on their momentary primary symptoms (pain and fatigue), and mood state (negative and positive). For each measure, day-mean aggregated values were computed and analyzed using linear multilevel (mixed model) regression analysis. Fixed factor results showed that symptoms were associated with both negative mood state (beta = 0.47) and positive mood state (beta = -0.59). Random results, however, indicated large inter-individual differences, with correlations varying between 0.17 and 0.99 for negative affect, and between -0.88 and 0.14 for positive affect. A substantial day-to-day contemporaneous association between symptoms and affect across subjects, as well as large inter-individual differences in this association, were demonstrated in patients with severe chronic SFD. EMA-data showing the relationship between both negative and (inverse) positive mood and complaints has potential clinical relevance: providing SFD patients with feedback consisting of their personal day-to-day concurrency graph may promote their understanding of their own complaints in a broader context than the somatic area.

Huguet, Anna; McGrath, Patrick J.; Wheaton, Michael; Mackinnon, Sean P.; Rozario, Sharlene; Tougas, Michelle E. et al. (2015): Testing the Feasibility and Psychometric Properties of a Mobile Diary (myWHI) in Adolescents and Young Adults With Headaches. In: JMIR Mhealth Uhealth 3 (2), S. e39. DOI: 10.2196/mhealth.3879.

BACKGROUND: Headaches are prevalent among teens and young adults. Self-monitoring is essential for managing headaches and can be accomplished with the help of electronic headache diaries. An increasing number of electronic headache diaries exist, yet the absence of quality standards compromises their use for research and clinical purposes. OBJECTIVE: Our goal was to develop and test the usability, feasibility, and psychometric properties of an electronic diary iPhone application for self-monitoring by adolescents and young adults with headaches. METHODS: We used an iterative participatory design to develop and test our electronic headache diary. Participants aged 14-28 years old with recurrent headaches were recruited internationally. Screening and consent were conducted online. Following completion of an online pre-questionnaire, participants downloaded the diary to use in their natural environment for 14 days. An online post-questionnaire was completed following testing. The diary’s usability and feasibility were tested first and determined to be complete when improvements to the diary did not result in a statistically significant impact on indicators of feasibility and adherence. Interviews were conducted with participants of usability and feasibility testing. The psychometric properties of the diary were then tested, and a case study analysis of one participant was completed. RESULTS: Three cycles to test the usability and feasibility were conducted. Each cycle included 11-19 unique participants ranging in age from 16 to 28 years. Following the testing period for each cycle, 15% to 25% of participants took part in the post-cycle interview. Participants perceived the final version of the diary as useful, easy to learn, and efficient to use. Psychometric properties were then tested with a sample of 65 participants (6 aged 14-17 years old; 59 aged 18-28 years old). All items in the diary had substantial between- and within-subjects variability (percent of variance for the two participant groups ranged from 20.64 to 75.60 and 23.74 to 79.21, respectively). Moreover, the Migraine Disability Assessment (MIDAS) included in the diary had adequate between-subjects reliability (R1F=0.66, RKF=0.98), but low within-subjects reliability (RC=0.51). Critical elements of the diary demonstrated adequate convergent and concurrent validity, particularly in the older age group (18-28 years). The validity of some critical elements of the diary could not be explored in the younger age group due to the small subgroup size. The case study provides an example of the potential utility of the diary. CONCLUSIONS: Our electronic headache diary was shown to be a usable and feasible self-monitoring tool when used by adolescents and young adults with headaches for 14 days. This study provides preliminary support of its psychometric properties. Our diary has the potential for helping users to better understand their headaches and, consequently, to change behaviors to improve self-management of their headaches. Its effectiveness as a component of an intervention will be the focus of future research.

Jakubowski, Kelly; Farrugia, Nicolas; Halpern, Andrea R.; Sankarpandi, Sathish K.; Stewart, Lauren (2015): The speed of our mental soundtracks: Tracking the tempo of involuntary musical imagery in everyday life. In: Memory & Cognition. DOI: 10.3758/s13421-015-0531-5.

The study of spontaneous and everyday cognitions is an area of rapidly growing interest. One of the most ubiquitous forms of spontaneous cognition is involuntary musical imagery (INMI), the involuntarily retrieved and repetitive mental replay of music. The present study introduced a novel method for capturing temporal features of INMI within a naturalistic setting. This method allowed for the investigation of two questions of interest to INMI researchers in a more objective way than previously possible, concerning (1) the precision of memory representations within INMI and (2) the interactions between INMI and concurrent affective state. Over the course of 4 days, INMI tempo was measured by asking participants to tap to the beat of their INMI with a wrist-worn accelerometer. Participants documented additional details regarding their INMI in a diary. Overall, the tempo of music within INMI was recalled from long-term memory in a highly veridical form, although with a regression to the mean for recalled tempo that parallels previous findings on voluntary musical imagery. A significant positive relationship was found between INMI tempo and subjective arousal, suggesting that INMI interacts with concurrent mood in a similar manner to perceived music. The results suggest several parallels between INMI and voluntary imagery, music perceptual processes, and other types of involuntary memories.

Jasper, Fabian; Hiller, Wolfgang; Berking, Matthias; Rommel, Thilo; Witthöft, Michael (2015): The affective response to health-related information and its relationship to health anxiety: An ambulatory approach. In: Cognition and Emotion 29 (4), S. 714–722. DOI: 10.1080/02699931.2014.930022.

Affective reactions to health-related information play a central role in health anxiety. Therefore, using ambulatory assessment, we analysed the time course of negative affect in a control group (CG, n = 60) which only rated their negative affect and an experimental group (EG, n = 97) which also rated the presence of somatic symptoms (e.g., back pain). By means of mixed regression models, we observed a decline of negative affect following the symptom self-ratings in the EG and a stable affect in the CG. The decline of negative affect was not moderated by the degree of health anxiety. Our findings might indicate that evaluating one’s health status leads to a general reduction of negative affect in healthy individuals. The results of the study are in line with a bidirectional symptom perception model and underline the crucial role of affect regulation in the processing of health-related information.

Johnson, Linda B.; Sumner, Sean; Duong, Tina; Yan, Posu; Bajcsy, Ruzena; Abresch, R. Ted et al. (2015): Validity and reliability of smartphone magnetometer-based goniometer evaluation of shoulder abduction – A pilot study. In: Man Ther. DOI: 10.1016/j.math.2015.03.004.

BACKGROUND: Goniometers are commonly used by physical therapists to measure range-of-motion (ROM) in the musculoskeletal system. These measurements are used to assist in diagnosis and to help monitor treatment efficacy. With newly emerging technologies, smartphone-based applications are being explored for measuring joint angles and movement. OBJECTIVE: This pilot study investigates the intra- and inter-rater reliability as well as concurrent validity of a newly-developed smartphone magnetometer-based goniometer (MG) application for measuring passive shoulder abduction in both sitting and supine positions, and compare against the traditional universal goniometer (UG). DESIGN: This is a comparative study with repeated measurement design. METHODS: Three physical therapists utilized both the smartphone MG and a traditional UG to measure various angles of passive shoulder abduction in a healthy subject, whose shoulder was positioned in eight different positions with pre-determined degree of abduction while seated or supine. Each therapist was blinded to the measured angles. Concordance correlation coefficients (CCCs), Bland-Altman plotting methods, and Analysis of Variance (ANOVA) were used for statistical analyses. RESULTS: Both traditional UG and smartphone MG were reliable in repeated measures of standardized joint angle positions (average CCC > 0.997) with similar variability in both measurement tools (standard deviation (SD) +/- 4 degrees ). Agreement between the UG and MG measurements was greater than 0.99 in all positions. CONCLUSION: Our results show that the smartphone MG has equivalent reliability compared to the traditional UG when measuring passive shoulder abduction ROM. With concordant measures and comparable reliability to the UG, the newly developed MG application shows potential as a useful tool to assess joint angles.

Kennedy, Ashley P.; Epstein, David H.; Jobes, Michelle L.; Agage, Daniel; Tyburski, Matthew; Phillips, Karran A. et al. (2015): Continuous in-the-field measurement of heart rate: Correlates of drug use, craving, stress, and mood in polydrug users. In: Drug Alcohol Depend 151, S. 159–166. DOI: 10.1016/j.drugalcdep.2015.03.024.

BACKGROUND: Ambulatory physiological monitoring could clarify antecedents and consequences of drug use and could contribute to a sensor-triggered mobile intervention that automatically detects behaviorally risky situations. Our goal was to show that such monitoring is feasible and can produce meaningful data. METHODS: We assessed heart rate (HR) with AutoSense, a suite of biosensors that wirelessly transmits data to a smartphone, for up to 4 weeks in 40 polydrug users in opioid-agonist maintenance as they went about their daily lives. Participants also self-reported drug use, mood, and activities on electronic diaries. We compared HR with self-report using multilevel modeling (SAS Proc Mixed). RESULTS: Compliance with AutoSense was good; the data yield from the wireless electrocardiographs was 85.7%. HR was higher when participants reported cocaine use than when they reported heroin use (F(2,9)=250.3, p<.0001) and was also higher as a function of the dose of cocaine reported (F(1,8)=207.7, p<.0001). HR was higher when participants reported craving heroin (F(1,16)=230.9, p<.0001) or cocaine (F(1,14)=157.2, p<.0001) than when they reported of not craving. HR was lower (p<.05) in randomly prompted entries in which participants reported feeling relaxed, feeling happy, or watching TV, and was higher when they reported feeling stressed, being hassled, or walking. CONCLUSIONS: High-yield, high-quality heart-rate data can be obtained from drug users in their natural environment as they go about their daily lives, and the resultant data robustly reflect episodes of cocaine and heroin use and other mental and behavioral events of interest.

Keoleian, Victoria; Polcin, Douglas; Galloway, Gantt P. (2015): Text messaging for addiction: a review. In: J Psychoactive Drugs 47 (2), S. 158–176. DOI: 10.1080/02791072.2015.1009200.

Individuals seeking treatment for addiction often experience barriers due to cost, lack of local treatment resources, or either school or work schedule conflicts. Text-messaging-based addiction treatment is inexpensive and has the potential to be widely accessible in real time. We conducted a comprehensive literature review identifying 11 published, randomized controlled trials (RCTs) evaluating text-messaging-based interventions for tobacco smoking, four studies for reducing alcohol consumption, one pilot study in former methamphetamine (MA) users, and one study based on qualitative interviews with cannabis users. Abstinence outcome results in RCTs of smokers willing to make a quit attempt have been positive overall in the short term and as far out as at six and 12 months. Studies aimed at reducing alcohol consumption have been promising. More data are needed to evaluate the feasibility, acceptability, and efficacy of this approach for other substance use problems.

Kim, Jinhyuk; Nakamura, Toru; Kikuchi, Hiroe; Yoshiuchi, Kazuhiro; Sasaki, Tsukasa; Yamamoto, Yoshiharu (2015): Co-Variation of Depressive Mood and Spontaneous Physical Activity in Major Depressive Disorder: Towards Continuous Monitoring of Depressive Mood. In: IEEE J Biomed Health Inform. DOI: 10.1109/JBHI.2015.2440764.

The objective evaluation of depressive mood is considered to be useful for the diagnosis and treatment of depressive disorders. Thus, we investigated psycho-behavioral correlates, particularly the statistical associations between momentary depressive mood and behavioral dynamics measured objectively, in patients with major depressive disorder (MDD) and healthy subjects. Patients with MDD (n = 14) and healthy subjects (n = 43) wore a watch-type computer device and rated their momentary symptoms using ecological momentary assessment. Spontaneous physical activity in daily life, referred to as locomotor activity, was also continuously measured by an activity monitor built into the device. A multilevel modeling approach was used to model the associations between changes in depressive mood scores and the local statistics of locomotor activity simultaneously measured. We further examined the cross-validity of such associations across groups. The statistical model established indicated that worsening of depressive mood was associated with increased intermittency of locomotor activity, as characterized by a lower mean and higher skewness. The model was cross-validated across groups, suggesting that the same psycho-behavioral correlates are shared by both healthy subjects and patients, although the latter had significantly higher mean levels of depressive mood scores. Our findings suggest the presence of robust as well as common associations between momentary depressive mood and behavioral dynamics in healthy individuals and patients with depression, which may lead to the continuous monitoring of the pathogenic processes (from healthy states) and pathological states of MDD.

Koster, Brian; Sondergaard, Jens; Nielsen, Jesper B.; Allen, Martin; Bjerregaard, Mette; Olsen, Anja; Bentzen, Joan (2015): Feasibility of smartphone diaries and personal dosimeters to quantitatively study exposure to ultraviolet radiation in a small national sample. In: Photodermatol Photoimmunol Photomed. DOI: 10.1111/phpp.12179.

BACKGROUND: In 2007, a national skin cancer prevention campaign was launched to reduce the UV exposure of the Danish population. To improve campaign evaluation a questionnaire validation using UV-dosimeters was initiated. AIM: To show the feasibility of dosimeters for national representative studies and of smartphones as a data collection tool. MATERIALS AND METHODS: Participants were sent a dosimeter which they wore for 7 days, received a short diary questionnaire by text message each day and subsequently a longer questionnaire. Correlation between responses from questionnaire, smartphone diaries and dosimeters were examined. RESULTS: This study shows a 99.5% return rate (n = 205) of the dosimeters by ordinary mail and high response-rates for a smartphone questionnaire dairy. Correlation coefficients for outdoor-time reported through smartphones and dosimeters as average by week 0.62 (0.39-0.77), P < 0.001 (n = 40). Correlation coefficient for outdoor time estimated by questionnaire and dosimeters were 0.42 (0.11-0.64), P = 0.008. The subjective perception of the weather was the only covariate significantly influencing questionnaire estimates of actual outdoor exposure. We showed that dosimeter studies are feasible in national settings and that smartphones are a useful tool for monitoring and collecting UV behavior data. CONCLUSION: We found diary data reported on a daily basis through smartphones more strongly associated with actual outdoor time than questionnaire data. Our results demonstrate tools and possible considerations for executing a UV behavior questionnaire validation.

Koval, Peter; Brose, Annette; Pe, Madeline L.; Houben, Marlies; Erbas, Yasemin; Champagne, Dominique; Kuppens, Peter (2015): Emotional Inertia and External Events: The Roles of Exposure, Reactivity, and Recovery. In: Emotion. DOI: 10.1037/emo0000059.

Increased moment-to-moment predictability, or inertia, of negative affect has been identified as an important dynamic marker of psychological maladjustment, and increased vulnerability to depression in particular. However, little is known about the processes underlying emotional inertia. The current article examines how the emotional context, and people’s responses to it, are related to emotional inertia. We investigated how individual differences in the inertia of negative affect (NA) are related to individual differences in exposure, reactivity, and recovery from emotional events, in daily life (assessed using experience sampling) as well as in the lab (assessed using an emotional film-clip task), among 200 participants commencing their first year of tertiary education. This dual-method approach allowed us to assess affective responding on different timescales, and in response to standardized as well as idiographic emotional stimuli. Our most consistent finding, across both methods, was that heightened NA inertia is related to decreased NA recovery following negative stimuli, suggesting that higher levels of inertia may be mostly driven by impairments in affect repair following negative events.

Kraus, Nicole; Lindenberg, Julia; Zeeck, Almut; Kosfelder, Joachim; Vocks, Silja (2015): Immediate Effects of Body Checking Behaviour on Negative and Positive Emotions in Women with Eating Disorders: An Ecological Momentary Assessment Approach. In: Eur Eat Disord Rev. DOI: 10.1002/erv.2380.

OBJECTIVES: Cognitive-behavioural models of eating disorders state that body checking arises in response to negative emotions in order to reduce the aversive emotional state and is therefore negatively reinforced. This study empirically tests this assumption. METHODS: For a seven-day period, women with eating disorders (n = 26) and healthy controls (n = 29) were provided with a handheld computer for assessing occurring body checking strategies as well as negative and positive emotions. Serving as control condition, randomized computer-emitted acoustic signals prompted reports on body checking and emotions. RESULTS: There was no difference in the intensity of negative emotions before body checking and in control situations across groups. However, from pre- to post-body checking, an increase in negative emotions was found. This effect was more pronounced in women with eating disorders compared with healthy controls. DISCUSSION: Results are contradictory to the assumptions of the cognitive-behavioural model, as body checking does not seem to reduce negative emotions. Copyright (c) 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Kuroi, Ryuta; Minakuchi, Hajime; Hara, Emilio Satoshi; Kawakami, Aya; Maekawa, Kenji; Okada, Hiroki; Kuboki, Takuo (2015): A risk factor analysis of accumulated postoperative pain and swelling sensation after dental implant surgery using a cellular phone-based real-time assessment. In: J Prosthodont Res 59 (3), S. 194–198. DOI: 10.1016/j.jpor.2015.05.003.

PURPOSE: The purpose of this study was to identify the related risk factors of dental implant accumulated postoperative pain and swelling by cellular phone-based assessment. METHODS: Subjects were a consecutive series of patients who received oral implant surgery at Okayama University Hospital. Cellular phone-based questionnaire was sent at pre-set schedule to each subject every 2h on the day of surgery, and every 24h from the 2nd to 7th day post-surgery. Subjects replied in real-time the pain and swelling levels at the operated sites by an 11- and 4-grade rating-scale questionnaire. Overall intensity of individual pain and swelling was calculated by means of area under curve that drew by their time-dependent changes. Predictor variables were age, gender, presence of diabetes mellitus and/or hypertension (DM/HT), history of implant surgery, number of inserted implants, flap operation, surgical duration, pre-surgery anxiety, osteoplasty, bone quality, premedication, dosage of prescribed analgesics and local anesthesia and accumulated postoperative pain/swelling. Compliance rate and risk factors correlated with accumulated postoperative pain and swelling were calculated by multiple regression analysis. RESULTS: Final subjects were 18 females and 7 male (mean age: 59.3+/-7.32 yrs). Significant factors correlated with accumulated postoperative pain were DM/HT, surgical duration, premedication, bone quality, pre-surgery anxiety and postoperative swelling (R(2)=0.769, p=0.001, 0.013, 0.032, 0.007, 0.035 and 0.007, respectively). Meanwhile, significant factors associated with postoperative swelling were postoperative pain, DM/HT and bone quality (R(2)=0.365, p=0.002, 0.004, 0.008, respectively). CONCLUSION: These results suggested DM/HT and bone quality are correlated to overall intensity of postoperative pain and swelling.

Kwasnicka, Dominika; Dombrowski, Stephan U.; White, Martin; Sniehotta, Falko F. (2015): Data-Prompted Interviews: Using Individual Ecological Data to Stimulate Narratives and Explore Meanings. In: Health Psychol. DOI: 10.1037/hea0000234.

OBJECTIVE: An emerging trend in qualitative research is to use individual participant data to stimulate narratives in interviews. This article describes the method of the data-prompted interview (DPI) and highlights its potential benefits and challenges. METHOD: DPIs use personal ecological data gathered prior to the interview to stimulate discussion during the interview. Various forms of data can be used including photographs, videos, audio recordings, graphs, and text. This data can be gathered by the researcher or generated by the participant and may utilize ecological momentary assessment. RESULTS: Using individual data in DPIs can stimulate visual and auditory senses, enhance memory, and prompt rich narratives anchored in personal experiences. For the researcher, DPIs provide an opportunity to explore the meaning of the data and to explain data patterns. For the participant, presented stimuli give guidance for discussion and allow them to reflect. The challenges associated with conducting DPIs include practical issues such as data selection and presentation. Data analyses require narratives to be interpreted together with the data. Ethical challenges of DPI include concerns around data anonymity and sensitivity. CONCLUSIONS: Combining various sources of data to stimulate the interview provides a novel opportunity to enhance participants’ memories and to meaningfully assess and analyze data patterns. In the context of health promotion and illness prevention, DPI offers a unique opportunity to explore reasons, opinions, and motivations for health-related behaviors in the light of previously gathered data.

Lalloo, Chitra; Jibb, Lindsay A.; Rivera, Jordan; Agarwal, Arnav; Stinson, Jennifer N. (2015): ‘There’s a pain app for that’: Review of patient-targeted smartphone applications for pain management. In: The Clinical Journal of Pain 31 (6), S. 557–563. DOI: 10.1097/AJP.0000000000000171.

Objectives: There are a growing number of pain self-management applications (apps) available for users to download on personal smartphones. The purpose of this study was to critically appraise the content and self-management functionality of currently available pain apps. Methods: An electronic search was conducted between May and June 2014 of the official stores for the 4 major operating systems. Two authors independently identified patient-focused apps with a stated goal of pain management. Discrepancies regarding selection were resolved through discussion with a third party. Metadata from all included apps were abstracted into a standard form. The content and functionality of each app as it pertained to pain self-management was rated. Results: A total of 279 apps met the inclusion criteria. Pain self-care skill support was the most common self-management function (77.4%). Apps also purported providing patients with the ability to engage in pain education (45.9%), self-monitoring (19%), social support (3.6%), and goal-setting (0.72%). No apps were comprehensive in terms of pain self-management, with the majority of apps including only a single self-management function (58.5%). In addition, only 8.2% of apps included a health care professional in their development, not a single app provided a theoretical rationale, and only 1 app underwent scientific evaluation. Discussion: Currently available pain self-management apps for patients are simplistic, lack the involvement of health care professionals in their development, and have not been rigorously tested for effectiveness on pain-related health outcomes. There is a need to develop and test theoretically and evidence-based apps to better support patients with accessible pain care self-management.

Law, Mary Kate; Furr, R. Michael; Arnold, Elizabeth Mayfield; Mneimne, Malek; Jaquett, Caroline; Fleeson, William (2015): Does Assessing Suicidality Frequently and Repeatedly Cause Harm? A Randomized Control Study. In: Psychol Assess. DOI: 10.1037/pas0000118.

Assessing suicidality is common in mental health practice and is fundamental to suicide research. Although necessary, there is significant concern that such assessments have unintended harmful consequences. Using a longitudinal randomized control design, the authors evaluated whether repeated and frequent assessments of suicide-related thoughts and behaviors negatively affected individuals, including those at-risk for suicide-related outcomes. Adults (N = 282), including many diagnosed with borderline personality disorder (BPD), were recruited through psychiatric outpatient clinics and from the community at large, and were randomly assigned to assessment groups. A control assessment group responded to questions regarding negative psychological experiences several times each day during a 2-week main observation phase. During the same observation period, an intensive suicide assessment group responded to the same questions, along with questions regarding suicidal behavior and ideation. Negative psychological outcomes were measured during the main observation phase (for BPD symptoms unrelated to suicide and for BPD-relevant emotions) and/or at the end of each week during the main observation phase and monthly for 6 months thereafter (for all outcomes, including suicidal ideation and behavior). Results revealed little evidence that intensive suicide assessment triggered negative outcomes, including suicidal ideation or behavior, even among people with BPD. A handful of effects did reach or approach significance, though these were temporary and nonrobust. However, given the seriousness of some outcomes, the authors recommend that researchers or clinicians who implement experience sampling methods including suicide-related items carefully consider the benefits of asking about suicide and to inform participants about possible risks.

Lehman, Barbara J.; Cane, Arianna C.; Tallon, Shannon J.; Smith, Stephanie F. (2015): Physiological and emotional responses to subjective social evaluative threat in daily life. In: Anxiety, Stress & Coping: An International Journal 28 (3), S. 321–339. DOI: 10.1080/10615806.2014.968563.

Background and Objectives: This study examined concurrent and delayed emotional and cardiovascular correlates of naturally occurring experiences with subjective social evaluative threat (SSET) and tested whether individual differences in social interaction anxiety moderated those associations. Methods: Sixty-eight participants wore ambulatory blood pressure monitors for three days. Following each blood pressure reading, participants reported on SSET and negative emotions, yielding 1770 momentary measures. Results: Multilevel modeling suggested that reports of greater SSET uniquely predicted elevations in anxiety and embarrassment, with elevations in anxiety, embarrassment, and shame extending to the hour following SSET. Reports of concurrent and previous-hour SSET also predicted cardiovascular elevations. Linkages between SSET and anxiety and shame, but not cardiovascular measures, were moderated by social interaction anxiety. Those higher in social interaction anxiety showed especially strong associations between SSET and both concurrent and delayed anxiety and greater delayed shame. Conclusions: This research suggests an important role for anxiety, embarrassment, and shame as emotional consequences of naturally occurring evaluative threat, especially for those who are more socially anxious. Further, this work replicates other naturalistic studies that have documented increased blood pressure at times of SSET and extends that work by documenting cardiovascular responses into the following hour.

Lewis, Lucy Kate; Maher, Carol; Belanger, Kevin; Tremblay, Mark; Chaput, Jean-Philippe; Olds, Tim (2015): At the Mercy of the Gods: Associations Between Weather, Physical Activity and Sedentary Time in Children. In: Pediatr Exerc Sci. DOI: 10.1123/pes.2015-0076.

OBJECTIVES: This study investigated associations between weather conditions, physical activity and sedentary time in primary school-aged children in Australia and Canada. METHODS: Cross-sectional data on 9 to 11 year old children from the Australian (n=491) and Canadian (n=524) sites of the International Study of Childhood Obesity, Lifestyle and the Environment were used. Minutes of daily moderate-to-vigorous-physical-activity (MVPA) and sedentary time were determined from 7-day, 24 hour accelerometry (Actigraph GT3X+ triaxial accelerometer). Day-matched weather data (temperature, rainfall, snowfall, relative humidity, wind speed) were obtained from the closest weather station to participants’ schools. Covariates included; parental highest education level, day type, sex, and BMI z-scores. Generalised mixed model analyses allowing for clustering of participants within schools were completed. Scatterplots with Loess curves were created for maximum temperature, MVPA and sedentary time. RESULTS: Daily maximum temperature was significantly associated with MVPA and sedentary time in Australia (MVPA p = .05, sedentary p = .01) and Canada (p < .001, p = .001). Rainfall was negatively associated with MVPA in Australia (p < .001), and positively associated with sedentary time in Canada (p = .02). CONCLUSIONS: MVPA and sedentary time appear to be optimal when the maximum temperature ranges between 20omicronC and 25omicronC in both countries. The findings have implications for study design and interpretation for surveillance and intervention studies.

Lin, Yu-Hsuan; Lin, Yu-Cheng; Lee, Yang-Han; Lin, Po-Hsien; Lin, Sheng-Hsuan; Chang, Li-Ren et al. (2015): Time distortion associated with smartphone addiction: Identifying smartphone addiction via a mobile application (App). In: J Psychiatr Res 65, S. 139–145. DOI: 10.1016/j.jpsychires.2015.04.003.

BACKGROUND: Global smartphone penetration has brought about unprecedented addictive behaviors. AIMS: We report a proposed diagnostic criteria and the designing of a mobile application (App) to identify smartphone addiction. METHOD: We used a novel empirical mode decomposition (EMD) to delineate the trend in smartphone use over one month. RESULTS: The daily use count and the trend of this frequency are associated with smartphone addiction. We quantify excessive use by daily use duration and frequency, as well as the relationship between the tolerance symptoms and the trend for the median duration of a use epoch. The psychiatrists’ assisted self-reporting use time is significant lower than and the recorded total smartphone use time via the App and the degree of underestimation was positively correlated with actual smartphone use. CONCLUSIONS: Our study suggests the identification of smartphone addiction by diagnostic interview and via the App-generated parameters with EMD analysis.

Linas, Beth S.; Latkin, Carl; Genz, Andrew; Westergaard, Ryan P.; Chang, Larry W.; Bollinger, Robert C.; Kirk, Gregory D. (2015): Utilizing mHealth methods to identify patterns of high risk illicit drug use. In: Drug Alcohol Depend 151, S. 250–257. DOI: 10.1016/j.drugalcdep.2015.03.031.

INTRODUCTION: We assessed patterns of illicit drug use using mobile health (mHealth) methods and subsequent health care indicators among drug users in Baltimore, MD. METHODS: Participants of the EXposure Assessment in Current Time (EXACT) study were provided a mobile device for assessment of their daily drug use (heroin, cocaine or both), mood and social context for 30 days from November 2008 through May 2013. Real-time, self-reported drug use events were summed for individuals by day. Drug use risk was assessed through growth mixture modeling. Latent class regression examined the association of mHealth-defined risk groups with indicators of healthcare access and utilization. RESULTS: 109 participants were a median of 48.5 years old, 90% African American, 52% male and 59% HIV-infected. Growth mixture modeling identified three distinct classes: low intensity drug use (25%), moderate intensity drug use (65%) and high intensity drug use (10%). Compared to low intensity drug users, high intensity users were younger, injected greater than once per day, and shared needles. At the subsequent study visit, high intensity drug users were nine times less likely to be medically insured (adjusted OR: 0.10, 95%CI: 0.01-0.88) and at greater risk for failing to attend any outpatient appointments (aOR: 0.13, 95%CI: 0.02-0.85) relative to low intensity drug users. CONCLUSIONS: Real-time assessment of drug use and novel methods of describing sub-classes of drug users uncovered individuals with higher-risk behavior who were poorly utilizing healthcare services. mHealth holds promise for identifying individuals engaging in high-risk behaviors and delivering real-time interventions to improve care outcomes.

Liu, Fangchao; Chen, Panpan; Li, Dianjiang; Yang, Xueli; Huang, Jianfeng; Gu, Dongfeng (2015): Ambulatory blood pressure and blood pressure load responses to low sodium intervention in Han Chinese population. In: Clin Exp Hypertens, S. 1–6. DOI: 10.3109/10641963.2015.1026038.

We aimed to illustrate ambulatory blood pressure monitoring parameters responses to low sodium intake and their differences between salt-sensitive and non-salt-sensitive individuals. A total of 186 participants were included in this analysis. Twenty-four hour, day-time and night-time blood pressure (BP) and BP load decreased during low sodium intervention, especially in salt-sensitive (SS) group. After multivariable adjustment, 24-h systolic BP, diastolic BP, mean arterial pressure and BP load responses to low sodium intervention of SS individuals were more pronounced than those of non-salt-sensitive individuals. Thus, reducing salt intake is potentially needed for the prevention of hypertension, especially in SS individuals.

Lupton, Deborah; Jutel, Annemarie (2015): ‘It’s like having a physician in your pocket!’ A critical analysis of self-diagnosis smartphone apps. In: Soc Sci Med 133, S. 128–135. DOI: 10.1016/j.socscimed.2015.04.004.

More than 100,000 mobile phone software applications (‘apps’) have been designed for the dissemination of health and medical information and healthcare and public health initiatives. This article presents a critical analysis of self-diagnosis smartphone apps directed at lay people that were available on the Apple App Store and Google Play in mid-April 2014. The objective of the analysis is to contribute to the sociology of diagnosis and to critical digital health studies by investigating the phenomenon of digitised diagnosis via apps. We adopted a perspective that views apps as sociocultural artefacts. Our analysis of self-diagnosis apps suggests that they inhabit a contested and ambiguous site of meaning and practice. We found that app developers combined claims to medical expertise in conjunction with appeals to algorithmic authority to promote their apps to potential users. While the developers also used appeals to patient engagement as part of their promotional efforts, these were undermined by routine disclaimers that users should seek medical advice to effect a diagnosis. More research is required to investigate how lay people are negotiating the use of these apps, the implications for privacy of their personal data and the possible effects on the doctor-patient relationship and medical authority in relation to diagnosis.

Ly, Kien Hoa; Topooco, Naira; Cederlund, Hanna; Wallin, Anna; Bergstrom, Jan; Molander, Olof et al. (2015): Smartphone-Supported versus Full Behavioural Activation for Depression: A Randomised Controlled Trial. In: PLoS One 10 (5), S. e0126559. DOI: 10.1371/journal.pone.0126559.

BACKGROUND: There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment–including four face-to-face sessions and a smartphone application–was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression. METHODS: This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment. RESULTS: Results showed significant improvements in both groups across time on the primary outcome measure (within-group Cohen’s d=1.35; CI [-0.82, 3.52] to d=1.47; CI [-0.41, 3.35]; between group d=-0.13 CI [-2.37, 2.09] and d=-0.10 CI [-2.53, 2.33]). At the same time, the blended treatment reduced the therapist time with an average of 47%. CONCLUSIONS: We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone application as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression. TRIAL REGISTRATION: Cognitive Behavioral Therapy Treatment of Depression With Smartphone Support NCT01819025.

Martin, Corby K.; Miller, Anastasia C.; Thomas, Diana M.; Champagne, Catherine M.; Han, Hongmei; Church, Timothy (2015): Efficacy of SmartLoss, a smartphone-based weight loss intervention: results from a randomized controlled trial. In: Obesity (Silver Spring) 23 (5), S. 935–942. DOI: 10.1002/oby.21063.

OBJECTIVE: Test the efficacy of SmartLoss, a smartphone-based weight loss intervention, in a pilot study. DESIGN AND METHODS: A 12-week randomized controlled trial. Adults (25 </= BMI </= 35 kg/m2) were randomized to SmartLoss (n = 20) or an attention-matched Health Education control group (n = 20). SmartLoss participants were prescribed a 1,200 to 1,400 kcal/d diet and were provided with a smartphone, body weight scale, and accelerometer that wirelessly transmitted body weight and step data to a website. In the SmartLoss Group, mathematical models were used to quantify dietary adherence based on body weight and counselors remotely delivered treatment recommendations based on these objective data. The Health Education group received health tips via smartphone. A mixed model determined if change in weight and other endpoints differed between the groups (baseline was a covariate). RESULTS: The sample was 82.5% female. Mean +/- SD baseline age, weight (kg), and BMI were 44.4 +/- 11.8 years, 80.3 +/- 11.5 kg, and 29.8 +/- 2.9 kg/m2, respectively. One participant was lost to follow-up in each group before week 4. Weight loss was significantly (P < 0.001) larger in the SmartLoss (least squares mean +/- SEM: -9.4 +/- 0.5%) compared with the Health Education group (-0.6 +/- 0.5%). CONCLUSIONS: SmartLoss efficaciously promote clinically meaningful weight loss compared with an attention-matched control group. Smartphone-based interventions might prove useful in intervention dissemination.

Martinez-Nicolas, Antonio; Meyer, Martin; Hunkler, Stefan; Madrid, Juan Antonio; Rol, Maria Angeles; Meyer, Andrea H. et al. (2015): Daytime variation in ambient temperature affects skin temperatures and blood pressure: Ambulatory winter/summer comparison in healthy young women. In: Physiol Behav 149, S. 203–211. DOI: 10.1016/j.physbeh.2015.06.014.

It is widely accepted that cold exposure increases peripheral vascular resistance and arterial blood pressure (BP) and, hence, increases cardiovascular risk primarily in the elderly. However, there is a lack of concomitantly longitudinal recordings at personal level of environmental temperature (PET) and cardiophysiological variables together with skin temperatures (STs, the “interface-variable” between the body core and ambient temperature). To investigate the intra-individual temporal relationships between PET, STs and BP 60 healthy young women (52 completed the entire study) were prospectively studied in a winter/summer design for 26 h under real life conditions. The main hypothesis was tested whether distal ST (Tdist) mediates the effect of PET-changes on mean arterial BP (MAP).
Diurnal profiles of cardiophysiological variables (including BP), STs and PET were ambulatory recorded. Daytime variations between 0930 and 2030 h were analyzed in detail by intra-individual longitudinal path analysis. Additionally, time segments before, during and after outdoor exposure were separately analyzed.
In both seasons short-term variations in PET were positively associated with short-term changes in Tdist (not proximal ST, Tprox) and negatively with those in MAP. However, long-term seasonal differences in daytime mean levels were observed in STs but not in BP leading to non-significant inter-individual correlation between STs and BP. Additionally, higher individual body mass index (BMI) was significantly associated with lower daytime mean levels of Tprox and higher MAP suggesting Tprox as potential mediator variable for the association of BMI with MAP.
In healthy young women the thermoregulatory and BP-regulatory systems are closely linked with respect to short-term, but not long-term changes in PET. One hypothetical explanation could serve recent findings that thermogenesis in brown adipose tissue is activated in a cool environment, which could be responsible for the counter-regulation of cold induced increase of BP in winter leading to no seasonal differences in MAP.
Our findings suggest that the assessment of diurnal patterns of STs and PET, in addition to the conventional ambulatory BP monitoring, might improve individual cardiovascular risk prediction.

Massey, Kevin; Barnes, Marilyn J D; Villines, Dana; Goldstein, Julie D.; Pierson, Anna Lee Hisey; Scherer, Cheryl et al. (2015): What do I do? Developing a taxonomy of chaplaincy activities and interventions for spiritual care in intensive care unit palliative care. In: BMC Palliat Care 14, S. 10. DOI: 10.1186/s12904-015-0008-0.

BACKGROUND: Chaplains are increasingly seen as key members of interdisciplinary palliative care teams, yet the specific interventions and hoped for outcomes of their work are poorly understood. This project served to develop a standard terminology inventory for the chaplaincy field, to be called the chaplaincy taxonomy. METHODS: The research team used a mixed methods approach to generate, evaluate and validate items for the taxonomy. We conducted a literature review, retrospective chart review, focus groups, self-observation, experience sampling, concept mapping, and reliability testing. Chaplaincy activities focused primarily on palliative care in an intensive care unit setting in order to capture a broad cross section of chaplaincy activities. RESULTS: Literature and chart review resulted in 438 taxonomy items for testing. Chaplain focus groups generated an additional 100 items and removed 421 items as duplications. Self-Observation, Experience Sampling and Concept Mapping provided validity that the taxonomy items were actual activities that chaplains perform in their spiritual care. Inter-rater reliability for chaplains to identify taxonomy items from vignettes was 0.903. CONCLUSIONS: The 100 item chaplaincy taxonomy provides a strong foundation for a normative inventory of chaplaincy activities and outcomes. A deliberative process is proposed to further expand and refine the taxonomy to create a standard terminological inventory for the field of chaplaincy. A standard terminology could improve the ways inter-disciplinary palliative care teams communicate about chaplaincy activities and outcomes.

McCarthy, Danielle E.; Minami, Haruka; Yeh, Vivian M.; Bold, Krysten W. (2015): An experimental investigation of reactivity to ecological momentary assessment frequency among adults trying to quit smoking. In: Addiction. DOI: 10.1111/add.12996.

AIMS: Ecological Momentary Assessment (EMA) captures real-time reports in subjects’ natural environments. This experiment manipulated EMA frequency to estimate effects on abstinence and peri-cessation subjective experiences. DESIGN: In this randomized trial, subjects had an equal chance of being assigned to low-frequency (once) or high-frequency (6 times) daily EMA for 4 weeks (1 week pre- and 3 weeks post-cessation). Participants completed 6 office visits over 5 weeks and 6- and 12-week follow-up telephone interviews. SETTING: Community participants were recruited from central New Jersey, USA. PARTICIPANTS: 110 adult daily smokers seeking to quit smoking were included in intent-to-treat analyses of tobacco abstinence; 94 were available for secondary analyses of peri-cessation subjective ratings. MEASUREMENTS: Primary outcomes were cessation (abstaining at least 24 hours within 2 weeks of attempting to quit) and prolonged abstinence (no relapse between weeks 2 and 12 post-quit). Secondary outcomes were mean levels and growth in ratings of cigarette craving, affect, and quitting motivation and self-efficacy. FINDINGS: EMA frequency was unrelated to cessation (Odds Ratio = 1.37, 95% CI = 0.60-3.10) or prolonged abstinence (Odds Ratio = 1.04, 95% CI = 0.45-2.39) in intent-to-treat analyses. High-frequency EMA was associated with lower craving (B = -.54, SE = .18, p = .004, anxiety (B = -.42, SE = .17, p = .015), anger (B = -.47, SE = .14, p = .001), hunger (B = -.39, SE = .17, p = 0.25), and positive affect (B = -.43, SE = .20, p = .03). CONCLUSIONS: In smokers trying to quit, more frequent ecological momentary assessment (EMA) self-monitoring results in lower craving, anxiety, anger, hunger, and positive affect. It is not clear whether this translates into higher rates of smoking abstinence. This article is protected by copyright. All rights reserved.

Mcmullan, Ciaran J.; Yano, Yuichiro; Bakris, George L.; Kario, Kazuomi; Phillips, Robert A.; Forman, John P. (2015): Racial impact of diurnal variations in blood pressure on cardiovascular events in chronic kidney disease. In: J Am Soc Hypertens 9 (4), S. 299–306. DOI: 10.1016/j.jash.2015.02.005.

Ambulatory blood pressure parameters, nocturnal dipping and morning surge, are associated with cardiovascular outcomes in several populations. While significant variation exists between racial groups in ambulatory blood pressure measurements and the incidence of cardiovascular disease, the effect of race on the associations of dipping and morning surge with cardiovascular outcomes is unknown. In a prospective analysis of 197 African American and 197 Japanese individuals with non-diabetic chronic kidney disease matched by age and renal function, we analyzed the associations of dipping and morning surge with cardiovascular events for both races and assessed whether these relations differed by race. Higher sleep-trough morning surge was independently associated with cardiovascular events in Japanese (hazard ratio, 1.93 per 10 mm Hg; 95% confidence interval, 1.20-3.10) but not in African American participants, with race an effect modifier (P-value <.01). Dipping was not associated with cardiovascular events in either racial group. In individuals with chronic kidney disease, the association between morning surge and cardiovascular events appears to be dependent upon race, with higher morning surge a risk factors in Japanese but not in African Americans.

Miller, Megan A.; Rothenberger, Scott D.; Hasler, Brant P.; Donofry, Shannon D.; Wong, Patricia M.; Manuck, Stephen B. et al. (2015): Chronotype predicts positive affect rhythms measured by ecological momentary assessment. In: Chronobiology International 32 (3), S. 376–384. DOI: 10.3109/07420528.2014.983602.

Evening chronotype, a correlate of delayed circadian rhythms, is associated with depression. Altered positive affect (PA) rhythms may mediate the association between evening chronotype and depression severity. Consequently, a better understanding of the relationship between chronotype and PA may aid in understanding the etiology of depression. Recent studies have found that individuals with evening chronotype show delayed and blunted PA rhythms, although these studies are relatively limited in sample size, representativeness and number of daily affect measures. Further, published studies have not included how sleep timing changes on workday and non-workdays, or social jet lag (SJL) may contribute to the chronotype-PA rhythm link. Healthy non-depressed adults (n = 408) completed self-report affect and chronotype questionnaires. Subsequently, positive and negative affects were measured hourly while awake for at least two workdays and one non-workday by ecological momentary assessment (EMA). Sleep variables were collected via actigraphy and compared across chronotype groups. A cosinor variant of multilevel modeling was used to model individual and chronotype group rhythms and to calculate two variables: (1) amplitude of PA, or the absolute amount of daily variation from peak to trough during one period of the rhythm and (2) acrophase, or the time at which the peak amplitude of affect rhythms occurred. On workdays, individuals with evening chronotype had significantly lower PA amplitudes and later workday acrophase times than their morning type counterparts. In contrast to predictions, SJL was not found to be a mediator in the relationship between chronotype and PA rhythms. The association of chronotype and PA rhythms in healthy adults may suggest the importance of daily measurement of PA in depressed individuals and would be consistent with the hypothesis that evening chronotype may create vulnerability to depression via delayed and blunted PA rhythms.

Milyavskaya, Marina; Inzlicht, Michael; Hope, Nora; Koestner, Richard (2015): Saying “No” to Temptation: Want-to Motivation Improves Self-Regulation by Reducing Temptation Rather Than by Increasing Self-Control. In: J Pers Soc Psychol. DOI: 10.1037/pspp0000045.

Self-regulation has been conceptualized as the interplay between controlled and impulsive processes; however, most research has focused on the controlled side (i.e., effortful self-control). The present studies focus on the effects of motivation on impulsive processes, including automatic preferences for goal-disruptive stimuli and subjective reports of temptations and obstacles, contrasting them with effects on controlled processes. This is done by examining people’s implicit affective reactions in the face of goal-disruptive “temptations” (Studies 1 and 2), subjective reports of obstacles (Studies 2 and 3) and expended effort (Study 3), as well as experiences of desires and self-control in real-time using experience sampling (Study 4). Across these multiple methods, results show that want-to motivation results in decreased impulsive attraction to goal-disruptive temptations and is related to encountering fewer obstacles in the process of goal pursuit. This, in turn, explains why want-to goals are more likely to be attained. Have-to motivation, on the other hand, was unrelated to people’s automatic reactions to temptation cues but related to greater subjective perceptions of obstacles and tempting desires. The discussion focuses on the implications of these findings for self-regulation and motivation.

Monk, Rebecca Louise; Heim, Derek; Qureshi, Adam; Price, Alan (2015): “I have no clue what I drunk last night” using Smartphone technology to compare in-vivo and retrospective self-reports of alcohol consumption. In: PLoS One 10 (5), S. e0126209. DOI: 10.1371/journal.pone.0126209.

AIM: This research compared real-time measurements of alcohol consumption with retrospective accounts of alcohol consumption to examine possible discrepancies between, and contextual influences on, the different accounts. METHOD: Building on previous investigations, a specifically designed Smartphone technology was utilized to measure alcohol consumption and contextual influences in de facto real-time. Real-time data (a total of 10,560 data points relating to type and number of drinks and current social / environmental context) were compared with daily and weekly retrospective accounts of alcohol consumption. RESULTS: Participants reported consuming more alcoholic drinks during real-time assessment than retrospectively. For daily accounts a higher number of drinks consumed in real-time was related to a higher discrepancy between real-time and retrospective accounts. This effect was found across all drink types but was not shaped by social and environmental contexts. Higher in-vivo alcohol consumption appeared to be related to a higher discrepancy in retrospectively reported weekly consumption for alcohol beverage types other than wine. When including contextual factors into the statistical models, being with two or more friends (as opposed to being alone) decreased the discrepancy between real-time and retrospective reports, whilst being in the pub (relative to being at home) was associated with greater discrepancies. CONCLUSIONS: Overall, retrospective accounts may underestimate the amount of actual, real-time alcohol consumed. Increased consumption may also exacerbate differences between real-time and retrospective accounts. Nonetheless, this is not a global effect as environmental and social contexts interact with the type of alcohol consumed and the time frame given for reporting (weekly vs. daily retrospective). A degree of caution therefore appears warranted with regards to the use of retrospective self-report methods of recording alcohol consumption. Whilst real-time sampling is unlikely to be completely error free, it may be better able to account for social and environmental influences on self-reported consumption.

Mujagic, Z.; Leue, C.; Vork, L.; Lousberg, R.; Jonkers, D M A E; Keszthelyi, D. et al. (2015): The Experience Sampling Method – a new digital tool for momentary symptom assessment in IBS: an exploratory study. In: Neurogastroenterol Motil. DOI: 10.1111/nmo.12624.

BACKGROUND: Retrospective questionnaires are frequently used for symptom assessment in irritable bowel syndrome (IBS) patients, but are influenced by recall bias and circumstantial and psychological factors. These limitations may be overcome by random, repeated, momentary assessment during the day, using electronic Experience Sampling Methodology (ESM). Therefore, we compared symptom assessment by ESM to retrospective paper questionnaires in IBS patients. METHODS: Twenty-six IBS patients (Rome III) were included, of which 16 were diagnosed with panic disorder (DSM-IV-TR). Patients scored symptoms using end-of-day diaries during 14 days and the gastrointestinal symptom rating scale (GSRS) once. ESM was used on seven consecutive days during the same time period. KEY RESULTS: End-of-day diary abdominal pain scores were 0.4 (SE 0.1, p < 0.001) point higher (on a 1-to-5-point scale) compared to corresponding ESM mean-scores in IBS patients. The difference was even more pronounced for upper abdominal pain scores assessed by the GSRS (4.77 +/- 1.50) compared to ESM mean-scores (2.44 +/- 1.30, p < 0.001), both on 1-to-7-point scale. For flatulence, comparable results were found. Nausea and belching scores showed small, but significant differences between end-of-day diary and ESM. All tested symptoms were scored higher on GSRS compared to ESM mean-scores (p < 0.01). Affective comorbidity did not influence differences in pain reporting between methods. CONCLUSIONS & INFERENCES: IBS patients report higher scores for abdominal pain in retrospective questionnaires compared to ESM, with a tendency to report peak rather than average pain scores. ESM can provide more insight in symptom course and potential triggers, and may lead to a better understanding of IBS symptomatology.

Olff, Miranda (2015): Mobile mental health: a challenging research agenda. In: Eur J Psychotraumatol 6, S. 27882. DOI: 10.3402/ejpt.v6.27882.

The field of mobile health (“m-Health”) is evolving rapidly and there is an explosive growth of psychological tools on the market. Exciting high-tech developments may identify symptoms, help individuals manage their own mental health, encourage help seeking, and provide both preventive and therapeutic interventions. This development has the potential to be an efficient cost-effective approach reducing waiting lists and serving a considerable portion of people globally (“g-Health”). However, few of the mobile applications (apps) have been rigorously evaluated. There is little information on how valid screening and assessment tools are, which of the mobile intervention apps are effective, or how well mobile apps compare to face-to-face treatments. But how feasible is rigorous scientific evaluation with the rising demands from policy makers, business partners, and users for their quick release? In this paper, developments in m-Health tools-targeting screening, assessment, prevention, and treatment-are reviewed with examples from the field of trauma and posttraumatic stress disorder. The academic challenges in developing and evaluating m-Health tools are being addressed. Evidence-based guidance is needed on appropriate research designs that may overcome some of the public and ethical challenges (e.g., equity, availability) and the market-driven wish to have mobile apps in the “App Store” yesterday rather than tomorrow.

O’Reilly, Gillian A.; Huh, Jimi; Schembre, Susan M.; Tate, Eleanor B.; Pentz, Mary Ann; Dunton, Genevieve (2015): Association of usual self-reported dietary intake with ecological momentary measures of affective and physical feeling states in children. In: Appetite 92, S. 314–321. DOI: 10.1016/j.appet.2015.05.032.

BACKGROUND: Little is known about the relationship between dietary intake and affective and physical feeling states in children. PURPOSE: The current study used Ecological Momentary Assessment (EMA) to examine how usual dietary intake is cross-sectionally associated with both average affective and physical feeling state ratings and rating variability in children. METHODS: Children (N = 110, mean age = 11.0 +/- 1.2 years, 52.5% male, 30.1% Hispanic/Latino) completed EMA measures of affective and physical feeling states 3-7 times per day for a full or partial day (weekday evenings and weekend days and evenings) over a 4-day period. Usual intake of pre-selected dietary components was measured prior to the EMA measurement period using the Block Kids Food Screener. Statistical analyses included mixed models and mixed-effects location scale models. RESULTS: Greater usual fiber intake was cross-sectionally associated with higher average positive affect (PA) ratings, lower variability of NA ratings, and higher variability of physical fatigue ratings. Lower usual glycemic load of diet was cross-sectionally associated with lower variability of NA ratings. Lower usual added sugar intake was cross-sectionally associated with higher average physical energy ratings and lower variability of NA ratings. CONCLUSIONS: Although temporal precedence was not established by these findings, they indicate that characteristics of children’s usual dietary intake are cross-sectionally associated with both the average and variability of affective and physical feeling states. EMA offers a promising avenue through which to explore the associations between affective states and diet and has the potential to provide insight into nuances of this relationship.

Ottaviani, Cristina; Medea, Barbara; Lonigro, Antonia; Tarvainen, Mika; Couyoumdjian, Alessandro (2015): Cognitive rigidity is mirrored by autonomic inflexibility in daily life perseverative cognition. In: Biological Psychology 107, S. 24–30. DOI: 10.1016/j.biopsycho.2015.02.011.

Mind wandering (MW) can be persistent and therefore has been included in the repetitive thinking conceptualization. In line with a dimensional view of psychopathology, we hypothesized the existence of a MW-Perseverative Cognition (PC) continuum, where the latter is characterized by a rigid and defensive pattern with attentional, behavioral, affective, and autonomic perseverative manifestations. Ambulatory heart rate (HR) and variability (HRV) of 42 participants were recorded for 24h. Approximately every 30min during waking, subjects reported their ongoing thoughts and moods using electronic diaries. MW was characterized by less effort to inhibit the thought and less interference with ongoing activities, absence of mood worsening, and higher HRV compared to PC. Worse sleep quality was predicted by higher levels of trait rumination and daily PC. Results suggest that MW and PC represent the functional and pathological ends of a continuum, respectively.

Parke, Michael R.; Seo, Myeong-Gu; Sherf, Elad N. (2015): Regulating and facilitating: The role of emotional intelligence in maintaining and using positive affect for creativity. In: Journal of Applied Psychology 100 (3), S. 917–934. DOI: 10.1037/a0038452.

Although past research has identified the effects of emotional intelligence on numerous employee outcomes, the relationship between emotional intelligence and creativity has not been well established. We draw upon affective information processing theory to explain how two facets of emotional intelligence—emotion regulation and emotion facilitation—shape employee creativity. Specifically, we propose that emotion regulation ability enables employees to maintain higher positive affect (PA) when faced with unique knowledge processing requirements, while emotion facilitation ability enables employees to use their PA to enhance their creativity. We find support for our hypotheses using a multimethod (ability test, experience sampling, survey) and multisource (archival, self-reported, supervisor-reported) research design of early career managers across a wide range of jobs.

Pasyugina, Irina; Koval, Peter; Leersnyder, Jozefien de; Mesquita, Batja; Kuppens, Peter (2015): Distinguishing between level and impact of rumination as predictors of depressive symptoms: An experience sampling study. In: Cognition and Emotion 29 (4), S. 736–746. DOI: 10.1080/02699931.2014.932755.

Rumination—repetitively thinking about one’s emotional state, its causes and consequences—exacerbates negative mood and plays an important role in the aetiology and maintenance of depression. Yet, it is unclear whether increased vulnerability to depression is associated with simply how much a person ruminates, or the short-term impact rumination has on a person’s negative mood. In the current study, we distinguish between the level versus the impact of rumination, and we examine how each uniquely predicts changes in depressive symptoms over time in an undergraduate sample. Using experience sampling, we assessed students’ (N = 101) subjective experiences of positive and negative affect and their use of rumination and distraction in daily life for seven days. Participants also reported their depressive symptoms before and after the experience sampling. Increases in depressive symptoms over the week were predicted by how much people ruminated, but not by its impact on negative mood.

Pereira, Sara; Katzmarzyk, Peter T.; Gomes, Thayse Natacha; Borges, Alessandra; Santos, Daniel; Souza, Michele et al. (2015): Profiling physical activity, diet, screen and sleep habits in portuguese children. In: Nutrients 7 (6), S. 4345–4362. DOI: 10.3390/nu7064345.

Obesity in children is partly due to unhealthy lifestyle behaviours, e.g., sedentary activity and poor dietary choices. This trend has been seen globally. To determine the extent of these behaviours in a Portuguese population of children, 686 children 9.5 to 10.5 years of age were studied. Our aims were to: (1) describe profiles of children’s lifestyle behaviours; (2) identify behaviour pattern classes; and (3) estimate combined effects of individual/ socio-demographic characteristics in predicting class membership. Physical activity and sleep time were estimated by 24-h accelerometry. Nutritional habits, screen time and socio-demographics were obtained. Latent Class Analysis was used to determine unhealthy lifestyle behaviours. Logistic regression analysis predicted class membership. About 78% of children had three or more unhealthy lifestyle behaviours, while 0.2% presented no risk. Two classes were identified: Class 1-Sedentary, poorer diet quality; and Class 2-Insufficiently active, better diet quality, 35% and 65% of the population, respectively. More mature children (Odds Ratio (OR) = 6.75; 95%CI = 4.74-10.41), and boys (OR = 3.06; 95% CI = 1.98-4.72) were more likely to be overweight/obese. However, those belonging to Class 2 were less likely to be overweight/obese (OR = 0.60; 95% CI = 0.43-0.84). Maternal education level and household income did not significantly predict weight status (p >/= 0.05).

Pfaltz, Monique C.; Kolodyazhniy, Vitaliy; Blechert, Jens; Margraf, Jurgen; Grossman, Paul; Wilhelm, Frank H. (2015): Metabolic decoupling in daily life in patients with panic disorder and agoraphobia. In: J Psychiatr Res. DOI: 10.1016/j.jpsychires.2015.04.027.

Various studies have assessed autonomic and respiratory underpinnings of panic attacks, yet the psychophysiological functioning of panic disorder (PD) patients has rarely been examined under naturalistic conditions at times when acute attacks were not reported. We hypothesized that emotional activation in daily life causes physiologically demonstrable deviations from efficient metabolic regulation in PD patients. Metabolic coupling was estimated as within-individual correlations between heart rate (HR) and indices of metabolic activity, i.e., physical activity (measured by 3-axial accelerometry, Acc), and minute ventilation (Vm, measured by calibrated inductive plethysmography, as proxy for oxygen consumption). A total of 565 daytime hours were recorded in 19 PD patients and 20 healthy controls (HC). Pairwise cross-correlations of minute-by-minute averages of these metabolic indices were calculated for each participant and then correlated with several indices of self-reported anxiety. Ambulatory HR was elevated in PD (p = .05, d = 0.67). Patients showed reduced HR-Acc (p < .006, d = 0.97) and HR-Vm coupling (p < .009, d = 0.91). Combining Vm and Acc to predict HR showed the strongest group separation (p < .002, d = 1.07). Discriminant analyses, based on the combination of Vm and Acc to predict HR, classified 77% of all participants correctly. In PD, HR-Acc coupling was inversely related to trait anxiety sensitivity, as well as tonic and phasic daytime anxiety. The novel method that was used demonstrates that anxiety in PD may reduce efficient long-term metabolic coupling. Metabolic decoupling may serve as physiological characteristic of PD and might aid diagnostics for PD and other anxiety disorders. This measure deserves further study in research on health consequences of anxiety and psychosocial stress.

Phillips, Kristina T.; Phillips, Michael M.; Lalonde, Trent L.; Tormohlen, Kayla N. (2015): Marijuana use, craving, and academic motivation and performance among college students: An in-the-moment study. In: Addict Behav 47, S. 42–47. DOI: 10.1016/j.addbeh.2015.03.020.

INTRODUCTION: Marijuana is the most commonly used illicit substance in the U.S., with high rates among young adults in the state of Colorado. Chronic, heavy marijuana use can impact cognitive functioning, which has the potential to influence academic performance of college students. It is possible that craving for marijuana may further contribute to diminished cognitive and affective functioning, thus leading to poor outcomes for students. METHODS: College student marijuana users (n=57) were recruited based on heavy use and completed ecological momentary assessment (EMA) via text-messaging. The association between marijuana use and craving in a college setting was explored, as well as how these variables might relate to academic motivation, effort and success. The participants were sent text messages for two weeks, three times per day at random times. RESULTS: A temporal association between craving and marijuana use was found, where momentary craving positively predicted greater marijuana use. Similarly, as craving levels increased, the number of minutes spent studying decreased at the next assessment point. A negative association between momentary craving for marijuana and academic motivation was found in the same moment. Greater academic self-efficacy positively predicted cumulative GPA, while average minutes spent smoking marijuana was negatively related. CONCLUSIONS: Using EMA, marijuana craving and use were significantly related. These findings provide further evidence that heavy marijuana use is negatively associated with academic outcomes.

Pihet, Sandrine; Ridder, Jill de; Suter, Maya (2015): Ecological Momentary Assessment (EMA) Goes to Jail: Capturing Daily Antisocial Behavior in its Context, a Feasibility and Reliability Study in Incarcerated Juvenile Offenders. In: European Journal of Psychological Assessment. DOI: 10.1027/1015-5759/a000275.

Ecological Momentary Assessment (EMA) involves the repeated collection of data in everyday life. This method has helped uncover underlying mechanisms in several mental disorders. EMA studies are still scarce in adolescent patients and particularly incarcerated juvenile offenders (IJO), possibly due to their frequent rule-breaking and high impulsivity. This study evaluated the feasibility and reliability of EMA in IJO. One hundred three antisocial adolescents (mean age 14.8, 78% boys, including 52 IJO and 51 institutionalized antisocial adolescents, IAA) answered four times a day during 8 days questions about their antisocial behavior, negative affect, impulsivity, and fear of punishment, on a handheld computer. Staff members also regularly reported on each participant’s antisocial behavior. This first application of EMA in IJO overall supported its feasibility, with an excellent participation rate (95%) and a good compliance in completers (84%). About one-third of IJO participants dropped out, with no evidence of sampling bias across a wide range of indicators, while 96% of IAA completed EMA. No reactivity or lack of objectivity was observed. One- to two-thirds of the variance was within-person and reliability was acceptable to good. EMA can thus be reliably used in IJO to study the dynamics of daily antisocial behavior as it naturally unfolds in its context.

Pope, Zachary K.; DeFreitas, Jason M. (2015): The effects of body position and muscle activation on patellar tendon reflex properties. In: Physiol Meas 36 (7), S. 1429–1438. DOI: 10.1088/0967-3334/36/7/1429.

Our purpose was to examine the effects of body position and a low-intensity voluntary contraction on patellar tendon tap reflex properties.Surface electromyography, torque, and accelerometry signals were obtained from 30 subjects (25.0 +/- 4.6 years) during patellar tendon taps. These signals were used to quantify reflex magnitude and the subcomponents of reflex latency for each subject in the upright position (i.e. control), supine position, and during alpha-gamma coactivation (i.e. a low-intensity contraction). The Jendrassik maneuver was also performed to examine any potential benefits beyond that of standard reinforcement.Neither experimental condition significantly altered reflex magnitude. However, the supine body position condition resulted in a significant decrease in reflex latency (p = 0.037) which appears largely attributable to a decreased electromechanical delay. Interestingly, the low-intensity contraction had no effect on any of the latency components.The assessment of reflex latency can be improved by utilizing a supine body position. This effect may be due to the presence of slack within musculotendinous structures during the traditional upright position. A voluntary contraction, however, does not enhance the reflex response beyond that of standard reinforcement. Limitations regarding the use of a light contraction during tendon taps are discussed for future investigations.

Portell, Mariona; Anguera, M. Teresa; Hernandez-Mendo, Antonio; Jonsson, Gudberg K. (2015): Quantifying biopsychosocial aspects in everyday contexts: an integrative methodological approach from the behavioral sciences. In: Psychol Res Behav Manag 8, S. 153–160. DOI: 10.2147/PRBM.S82417.

Contextual factors are crucial for evaluative research in psychology, as they provide insights into what works, for whom, in what circumstances, in what respects, and why. Studying behavior in context, however, poses numerous methodological challenges. Although a comprehensive framework for classifying methods seeking to quantify biopsychosocial aspects in everyday contexts was recently proposed, this framework does not contemplate contributions from observational methodology. The aim of this paper is to justify and propose a more general framework that includes observational methodology approaches. Our analysis is rooted in two general concepts: ecological validity and methodological complementarity. We performed a narrative review of the literature on research methods and techniques for studying daily life and describe their shared properties and requirements (collection of data in real time, on repeated occasions, and in natural settings) and classification criteria (eg, variables of interest and level of participant involvement in the data collection process). We provide several examples that illustrate why, despite their higher costs, studies of behavior and experience in everyday contexts offer insights that complement findings provided by other methodological approaches. We urge that observational methodology be included in classifications of research methods and techniques for studying everyday behavior and advocate a renewed commitment to prioritizing ecological validity in behavioral research seeking to quantify biopsychosocial aspects.

Powell, Daniel J. H.; Moss-Morris, Rona; Liossi, Christina; Schlotz, Wolff (2015): Circadian cortisol and fatigue severity in relapsing-remitting multiple sclerosis. In: Psychoneuroendocrinology 56, S. 120–131. DOI: 10.1016/j.psyneuen.2015.03.010.

Cortisol is a key regulator of the immune system, energy metabolism, and stress, yet its relevance to fatigue experienced by people with relapsing-remitting multiple sclerosis (RRMS) remains uncertain. We examined cortisol secretory activity in RRMS and its association with fatigue severity between-individuals and within-individuals (day-to-day) using a case–control ecological momentary assessment design. While undergoing usual daily routines, 38 people with RRMS and 38 healthy control participants provided saliva samples at strategic time-points over 4 consecutive weekdays to measure the cortisol awakening response (CAR; 0, 30, and 45min after awakening) and the diurnal cortisol slope (DCS; 6 quasi-random samples provided between 1000h and 2000h). Recalled fatigue was measured at baseline, and daily fatigue was measured as the mean average of momentary fatigue ratings provided alongside each DCS sample. Multilevel modeling found CAR output was greater in RRMS than controls, and recalled fatigue in RRMS was associated with both lower waking cortisol level and larger awakening response. Day-to-day, the CAR was not associated with same-day fatigue levels in RRMS. Cortisol appears to have a role in fatigue experienced in RRMS, but whether it is a causal factor remains unclear.

Raatz, Susan K.; Jahns, Lisa; Johnson, LuAnn K.; Crosby, Ross; Mitchell, James E.; Crow, Scott et al. (2015): Nutritional adequacy of dietary intake in women with anorexia nervosa. In: Nutrients 7 (5), S. 3652–3665. DOI: 10.3390/nu7053652.

Understanding nutrient intake of anorexia nervosa (AN) patients is essential for the treatment. Therefore, estimates of total energy and nutrient consumption were made in a group of young women (19 to 30 years) with restricting and binge purge subtypes of AN participating in an ecological momentary assessment study. Participants completed three nonconsecutive 24-hour diet recalls. Mean nutrient intakes were stratified by subtype and by quartiles of energy intake and compared to the age specific Dietary Reference Intake (DRI) levels, as well as to the reported intakes from the What We Eat In America (WWEIA) dietary survey 2011-2012. Reported intake was determined for energy, macronutrients, and micronutrients. The mean body mass index (BMI) for all participants was 17.2 +/- 0.1 kg/m2. Reported nutrient intake was insufficient for participants in quartiles 1-3 of both AN subtypes when compared to the DRIs. Intake reported by participants in quartile 4 of both subgroups met requirements for most nutrients and even met or exceeded estimated energy needs. Counseling of AN patients should be directed to total food consumption to improve energy intake and to reduce individual nutritional gaps.

Rasmussen, Anne S.; Ramsgaard, Stine B.; Berntsen, Dorthe (2015): Frequency and functions of involuntary and voluntary autobiographical memories across the day. In: Psychology of Consciousness: Theory, Research, and Practice 2 (2), S. 185–205. DOI: 10.1037/cns0000042.

Involuntary autobiographical memories are memories of personally experienced events that come to mind spontaneously, whereas voluntary (i.e., deliberately recalled) memories are based on strategic retrieval processes, reflecting a goal-directed search. Previous work using an online recording methodology (i.e., a mechanical counter) has shown that involuntary compared with voluntary memories are 3 times as frequent in daily life, but there is evidence to suggest that frequency estimates of involuntary memories are sensitive to the methods used to make the recordings. Here, we use different types of online recording devices across 3 studies. In Study 1, using a mechanical counter, we replicated previous work showing that involuntary memories are almost 3 times as frequent as their voluntary counterparts. In Studies 2 and 3, we used smartphones to assess online frequency and found that the shift in recording device led to a decrease in the frequency of involuntary but not of voluntary memories. Furthermore, the smartphone assessment showed that involuntary memories were more frequent in the middle of the day, whereas voluntary retrieval was evenly distributed across the day. Voluntary relative to involuntary memories were estimated to serve more problem solving and directive functions in Studies 1 and 2 and as being more functionally relevant to the ongoing situation in Study 3. In conclusion, regardless of recording device, involuntary memories are at least as frequent as their voluntary counterparts, but are perceived to be less functionally relevant to the immediate retrieval context.

Reynolds, Grace L.; Fisher, Dennis G.; Laurenceau, Jean-Philippe; Fortenberry, J. Dennis (2015): An Electronic Daily Diary Study of Anal Intercourse in Drug-Using Women. In: AIDS Behav. DOI: 10.1007/s10461-015-1045-7.

Women (N = 138) with histories of illicit drug use were recruited into an electronic diary study that used Android smartphones for data collection. The diary was to be completed each day for 12 weeks using an “app” created in HTML5 and accessed over the Internet via smartphone. Data collection included information on sexual behaviors with up to 10 partners per day and contextual factors surrounding sexual behavior such as drug use before/after, type of sexual behavior (oral, vaginal, anal), and other activities such as using condoms for vaginal and anal intercourse and use of sexual lubricants. The sample was predominantly African American (58 %); 20 % Latina, 20 % White and 2 % reported as Other. Most women reported either less than a high school education (33 %) or having a high school diploma (33 %). The mean age was 39 years (SD = 11.78). Anal intercourse occurred on days when women also reported using illicit drugs, specifically methamphetamine and cocaine. Anal intercourse was not an isolated sexual activity, but took place on days when vaginal intercourse and giving and receiving oral sex also occurred along with illicit drug use. Anal intercourse also occurred on days when women reported they wanted sex. HIV prevention interventions must address the risks of anal intercourse for women, taking into account concurrent drug use and sexual pleasure that may reduce individual harm-reduction behaviors.

Riordan, Benjamin C.; Conner, Tamlin S.; Flett, Jayde A M; Scarf, Damian (2015): A Brief Orientation Week Ecological Momentary Intervention to Reduce University Student Alcohol Consumption. In: J Stud Alcohol Drugs 76 (4), S. 525–529.

OBJECTIVE: Orientation Week is a series of events at the beginning of the university year that introduces incoming students to university life. It is also the period of the academic year when students consume more alcohol than at any other time. Recently, we demonstrated that alcohol consumption during Orientation Week was related to alcohol consumption during the academic year. The aim of the present study was to determine whether a brief Ecological Momentary Intervention (EMI) implemented during Orientation Week could reduce alcohol consumption during Orientation Week and throughout the academic year. METHOD: Participants were 130 freshman-year university students (72 women, 58 men) randomly assigned to either an Ecological Momentary Assessment (EMA) condition or an EMA-EMI condition. In both conditions, participants reported pre-university, Orientation Week, and academic year weekend alcohol consumption. Those in the EMA-EMI condition also received EMI text messages promoting moderation every night during Orientation Week. RESULTS: Although the EMI did not reduce men’s drinking, women in the EMA-EMI condition, compared with women in the EMA condition, consumed significantly fewer drinks during Orientation Week, M = 17.1, SD = 13.3, vs. M = 26.4, SD = 22.5, respectively, t(70) = -1.927, p < .05, Cohen’s d = 0.473, and reported consuming fewer weekend drinks during the academic semester, M = 5.0, SD = 3.3, vs. M = 7.5, SD = 6.3, respectively, t(70) = -2.263, p < .05, d = 0.451. CONCLUSIONS: This study represents the first important step in reducing drinking among university students by developing and using EMIs during Orientation Week.

Rosen, Natalie O.; Muise, Amy; Bergeron, Sophie; Delisle, Isabelle; Baxter, Mary Lou (2015): Daily associations between partner responses and sexual and relationship satisfaction in couples coping with provoked vestibulodynia. In: Journal of Sexual Medicine 12 (4), S. 1028–1039. DOI: 10.1111/jsm.12840.

Introduction: Women with provoked vestibulodynia (PVD) experience a recurrent vulvo‐vaginal pain triggered primarily during sexual intercourse. Although affected couples report adverse effects on their sexual and global romantic relationships, few studies have examined interpersonal factors that may influence their sexual and relationship satisfaction. Cross‐sectional studies have shown that greater partner solicitous and negative responses and lower facilitative responses are associated with poorer sexual and relationship satisfaction in women with PVD. Aim: The aim of this study was to investigate the within‐person associations between partner responses to painful intercourse and the sexual and relationship satisfaction of affected couples. Methods: In a dyadic daily experience study, 69 women (Mage = 28.46, SD = 6.66) diagnosed with PVD and their cohabitating male partners (Mage = 30.29, SD = 8.13) reported on male partner responses, as well as sexual and relationship satisfaction on sexual intercourse days (M = 6.81; SD = 5.40) over 8 weeks. Main Outcome Measures: Dependent measures were the (i) Kansas Marital Satisfaction Scale and (ii) Global Measure of Sexual Satisfaction Scale. Results: On sexual intercourse days when women perceived more facilitative partner responses than usual and on days when they perceived lower negative partner responses than usual, they reported higher sexual and relationship satisfaction. On sexual intercourse days when men reported more solicitous responses than usual, both they and their female partners reported lower sexual satisfaction. Conclusions: Interventions aimed at improving the day‐to‐day sexual and relationship satisfaction of couples with PVD should target increasing facilitative and decreasing negative and solicitous partner responses.

Rosen, Paul J.; Walerius, Danielle M.; Fogleman, Nicholas D.; Factor, Perry I. (2015): The association of emotional lability and emotional and behavioral difficulties among children with and without ADHD. In: Atten Defic Hyperact Disord. DOI: 10.1007/s12402-015-0175-0.

Children with ADHD often demonstrate a pattern of emotional lability characterized by sudden and intense shifts in affect. Emotional lability has been linked to emotional and behavioral problems in children with and without ADHD, but few studies have examined emotional lability over time. This study examined the effects of emotional lability over time on the behavioral and emotional difficulties of children with and without ADHD using an ecological momentary assessment (EMA) methodology. One hundred and two children aged 8-12 years (56 with ADHD and 46 without ADHD) and their parents completed baseline measures of the children’s behavioral and emotional difficulties. Parents then completed a 28-day 3-times daily EMA assessment protocol to rate their child’s emotional lability. Results suggested that emotional lability was associated with internalizing and/or externalizing diagnoses independent of ADHD diagnostic status, but was not directly associated with ADHD. Hierarchical regression analyses supported ADHD diagnostic status as a moderator of the association of greater EMA-derived emotional lability with children’s behavioral difficulties, such that greater emotional lability was associated with greater behavioral difficulties among children with ADHD but not among children without ADHD. Results indicated that greater emotional lability was directly linked with greater emotional difficulties and that this relation was not moderated by ADHD diagnostic status. Overall, this study suggested that emotional lability is related to emotional difficulties independent of ADHD, but is differentially related to behavioral difficulties among children with and without ADHD.

Rudolph, Cort W.; Clark, Malissa A.; Jundt, Dustin K.; Baltes, Boris B. (2015): Differential Reactivity and the Within-person Job Stressor-Satisfaction Relationship. In: Stress Health. DOI: 10.1002/smi.2641.

An experience sampling methodology was used to study the direct and conditional within-person relationship between job stressors and job satisfaction. One hundred and one full-time administrative staff completed momentary measures of job stressors and job satisfaction three times a day on six different workdays over a 3-week period (N = 1818 observations). Multilevel random coefficients models were specified, and the results suggest that within-person stressors are negatively related to within-person job satisfaction. These results stand when controlling for the effects of time, demographics, work characteristics, baseline levels of job stressors and satisfaction, and between-person effects of job stressors. Furthermore, consistent with the differential reactivity model, the results suggest that the observed within-person stressors-satisfaction relationship is conditional upon locus of control and positive affect. Copyright (c) 2015 John Wiley & Sons, Ltd.

Runyan, Jason D.; Steinke, Ellen G. (2015): Virtues, ecological momentary assessment/intervention and smartphone technology. In: Front Psychol 6, S. 481. DOI: 10.3389/fpsyg.2015.00481.

Virtues, broadly understood as stable and robust dispositions for certain responses across morally relevant situations, have been a growing topic of interest in psychology. A central topic of discussion has been whether studies showing that situations can strongly influence our responses provide evidence against the existence of virtues (as a kind of stable and robust disposition). In this review, we examine reasons for thinking that the prevailing methods for examining situational influences are limited in their ability to test dispositional stability and robustness; or, then, whether virtues exist. We make the case that these limitations can be addressed by aggregating repeated, cross-situational assessments of environmental, psychological and physiological variables within everyday life-a form of assessment often called ecological momentary assessment (EMA, or experience sampling). We, then, examine how advances in smartphone application (app) technology, and their mass adoption, make these mobile devices an unprecedented vehicle for EMA and, thus, the psychological study of virtue. We, additionally, examine how smartphones might be used for virtue development by promoting changes in thought and behavior within daily life; a technique often called ecological momentary intervention (EMI). While EMA/I have become widely employed since the 1980s for the purposes of understanding and promoting change amongst clinical populations, few EMA/I studies have been devoted to understanding or promoting virtues within non-clinical populations. Further, most EMA/I studies have relied on journaling, PDAs, phone calls and/or text messaging systems. We explore how smartphone app technology provides a means of making EMA a more robust psychological method, EMI a more robust way of promoting positive change, and, as a result, opens up new possibilities for studying and promoting virtues.

Ruscio, Aimee C.; Muench, Christine; Brede, Emily; Waters, Andrew J. (2015): Effect of Brief Mindfulness Practice on Self-Reported Affect, Craving, and Smoking: A Pilot Randomized Controlled Trial Using Ecological Momentary Assessment. In: Nicotine Tob Res. DOI: 10.1093/ntr/ntv074.

INTRODUCTION: Despite efficacious pharmacological and behavioral treatments, most smokers attempt to quit without assistance and fail to quit. Mindfulness practice may be useful in smoking cessation. METHODS: This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on self-reported smoking behavior delivered to smokers on a Personal Digital Assistant (PDA) in the field. Adult community smokers (N = 44) were randomly assigned to a Brief-MP (n = 24) or Control (sham meditation; n = 20) group. Participants were instructed to smoke as much or as little as they liked. Participants carried a PDA for 2 weeks and were instructed to initiate 20 minutes of meditation (or control) training on the PDA daily, completing an assessment of cognitive and affective processes immediately afterwards. Additionally, they completed assessments at random times up to four times per day. Primary outcome variables were negative affect, craving, and cigarettes smoked per day, all self-reported. RESULTS: Thirty-seven participants provided EMA data totaling 1874 assessments. Linear Mixed Model analyses on EMA data revealed that Brief-MP (vs. Control) reduced overall negative affect, F(1, 1798) = 13.8, P = .0002; reduced craving immediately post-meditation, (Group x Assessment Type interaction, F(2, 1796) = 12.3, P = .0001); and reduced cigarettes smoked per day over time (Group x Day interaction, F(1, 436) = 5.50, P = .01). CONCLUSIONS: Brief-MP administered in the field reduced negative affect, craving, and cigarette use, suggesting it may be a useful treatment.

Ruscio, Aimee C.; Muench, Christine; Brede, Emily; Waters, Andrew J. (2015): Effect of Brief Mindfulness Practice on Self-Reported Affect, Craving, and Smoking: A Pilot Randomized Controlled Trial Using Ecological Momentary Assessment. In: Nicotine Tob Res. DOI: 10.1093/ntr/ntv074.

INTRODUCTION: Despite efficacious pharmacological and behavioral treatments, most smokers attempt to quit without assistance and fail to quit. Mindfulness practice may be useful in smoking cessation. METHODS: This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on self-reported smoking behavior delivered to smokers on a Personal Digital Assistant (PDA) in the field. Adult community smokers (N = 44) were randomly assigned to a Brief-MP (n = 24) or Control (sham meditation; n = 20) group. Participants were instructed to smoke as much or as little as they liked. Participants carried a PDA for 2 weeks and were instructed to initiate 20 minutes of meditation (or control) training on the PDA daily, completing an assessment of cognitive and affective processes immediately afterwards. Additionally, they completed assessments at random times up to four times per day. Primary outcome variables were negative affect, craving, and cigarettes smoked per day, all self-reported. RESULTS: Thirty-seven participants provided EMA data totaling 1874 assessments. Linear Mixed Model analyses on EMA data revealed that Brief-MP (vs. Control) reduced overall negative affect, F(1, 1798) = 13.8, P = .0002; reduced craving immediately post-meditation, (Group x Assessment Type interaction, F(2, 1796) = 12.3, P = .0001); and reduced cigarettes smoked per day over time (Group x Day interaction, F(1, 436) = 5.50, P = .01). CONCLUSIONS: Brief-MP administered in the field reduced negative affect, craving, and cigarette use, suggesting it may be a useful treatment.

Scaglioni-Solano, Pietro; Aragon-Vargas, Luis Fernando (2015): Gait characteristics and sensory abilities of older adults are modulated by gender. In: Gait Posture 42 (1), S. 54–59. DOI: 10.1016/j.gaitpost.2015.04.002.

Despite the general perception that women and men walk differently, little is known about the reasons for these differences, especially in older adults. Previous work on gender differences in older adults has focused on spatiotemporal parameters. This study aims to assess gender-related differences in gait spatiotemporal and quality parameters when walking on a flat walkway at two different self-selected speeds: comfortable and fast. Sensorimotor abilities (Strength, agility, standing balance, reaction time) were also compared by gender, and gender-specific associations between spatiotemporal and sensorimotor parameters and gait quality were studied. Two tri-axial accelerometers were used at head and pelvis levels to investigate spatiotemporal parameters (step length, velocity and cadence), and gait quality (harmonic ratios (HR) and attenuation of accelerations between body levels) in 122 older adults (90 women, 69.7+/-5.1y.o. and 32 men, 71.6+/-6.4y.o.). Both men and women walked with similar speed; however women presented faster cadence and shorter steps than men at both walking speeds. Women also walked with greater vertical HR (head and pelvis), mediolateral pelvis HR, and attenuation (mediolateral and anteroposterior) than men. Women had better control of standing balance on foam (eyes open and closed) and tandem test. Moreover, balance on foam, tandem test, step length and cadence were associated to gender-specific gait quality parameters. The aging process seems to be affecting men and women differently, thus, gender differences should be considered when preparing intervention programs to improve balance and gait in older populations or when establishing normative data for balance and gait in older adults.

Schnall, Rebecca (2015): Short message service use in clinical care through a simulation activity. In: J Nurs Educ 54 (5), S. 290–294. DOI: 10.3928/01484834-20150417-08.

BACKGROUND: Research has shown that the integration of informatics competencies into nursing education especially for Doctor of Nursing Practice (DNP) students, has been inadequate. This article reports on a Short Message Service (SMS) simulation activity for incorporating informatics knowledge and skills into the DNP curriculum. METHOD: DNP students participated in a 3-week simulated ecological momentary assessment using SMS technology. Students rated their experience through a survey and wrote a 1 page narrative describing their experience. Data were analyzed using descriptive statistics and open-ended coding. RESULTS: This simulation activity provided information for the future delivery of care using SMS. The cost-saving potential of follow-up messaging reimbursement for providers who use SMS may be a worthwhile investment of health care payers. CONCLUSIONS: This activity demonstrated the usefulness of SMS technology for helping patients manage their chronic health conditions. Use of SMS would be a reinforcing factor for providers in clinical care if it becomes reimbursable.

Schneider, Stefan; Stone, Arthur A. (2015): Ambulatory and diary methods can facilitate the measurement of patient-reported outcomes. In: Qual Life Res. DOI: 10.1007/s11136-015-1054-z.

PURPOSE: Ambulatory and diary methods of self-reported symptoms and well-being have received increasing interest in recent years. These methods are a valuable addition to traditional strategies for the assessment of patient-reported outcomes (PROs) in that they capture patients’ recent symptom experiences repeatedly in their natural environments. In this article, we review ways that incorporating diary methods into PRO measurement can facilitate research on quality of life. METHODS: Several diary methods are currently available, and they include “real-time” (Ecological Momentary Assessment) and “near-real-time” (end-of-day assessments, Day Reconstruction Method) formats. We identify the key benefits of these methods for PRO research. RESULTS: (1) In validity testing, diary assessments can serve as a standard for evaluating the ecological validity and for identifying recall biases of PRO instruments with longer-term recall formats. (2) In research and clinical settings, diaries have the ability to closely capture variations and dynamic changes in quality of life that are difficult or not possible to obtain from traditional PRO assessments. (3) In test construction, repeated diary assessments can expand understanding of the measurement characteristics (e.g., reliability, dimensionality) of PROs in that parameters for differences between people can be compared with those for variation within people. CONCLUSIONS: Diary assessment strategies can enrich the repertoire of PRO assessment tools and enhance the measurement of patients’ quality of life.

Schotanus-Dijkstra, Marijke; Pieterse, M. E.; Drossaert, C. H. C.; Westerhof, G. J.; Graaf, R. de; Have, M. ten et al. (2015): What factors are associated with flourishing? Results from a large representative national sample. In: Journal of Happiness Studies. DOI: 10.1007/s10902-015-9647-3.

Flourishing is the ultimate end-state in psychology and a key-concept in the field of positive psychology research. Flourishers are those individuals with both high levels of hedonic well-being and eudaimonic well-being. Although many researchers have focused on one or another of these domains, only a few have investigated the comprehensive state of flourishing. The purpose of this study was to examine the prevalence of flourishing and its association with socio-demographics, personality traits and situational factors. This study used data from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a national representative sample of adults in The Netherlands (n = 5303; 2010–2012). Findings were compared to having either high hedonic well-being or high eudaimonic well-being. Results showed that 37 % of the respondents were flourishers, mainly characterized by high levels of conscientiousness and extraversion and low levels of neuroticism. The situational factors of social support and positive life-events were significantly associated with flourishing when the analysis was controlled for socio-demographics and personality traits. Flourishing was most distinct from high hedonic well-being and showed parallelism with high eudaimonic well-being. More research is needed to establish a preferred flourishing instrument with validated cut-off points for flourishing and to understand the processes of situational factors that may underlie the promotion of flourishing. We recommend longitudinal designs and experience sampling studies to investigate the unique and modifiable predictors of flourishing. In addition, future research should include intervention studies that examine through which hedonic and eudaimonic pathways flourishing can be achieved.

Schuster, Randi Melissa; Mermelstein, Robin J.; Hedeker, Donald (2015): Acceptability and Feasibility of a Visual Working Memory Task in an Ecological Momentary Assessment Paradigm. In: Psychol Assess. DOI: 10.1037/pas0000138.

Neuropsychological performance has historically been measured in laboratory settings using standardized assessments. However, these methods may be inherently limited in generalizability. This concern may be mitigated with paradigms such as ecological momentary assessment (EMA). We evaluated the initial feasibility and acceptability of administering a visual working memory (VWM) task on handheld computers across 1 EMA study week among adolescents/young adults (N = 39). Participants also completed standardized laboratory neurocognitive measures to determine the extent to which EMA VWM performance mapped onto scores obtained in traditional testing environments. Compliance with the EMA protocol was high as participants responded to 87% of random prompts across the study week. As expected, EMA VWM performance was positively associated with laboratory measures of auditory and VWM, and these relationships persisted after adjusting for predicted intelligence. Further, discriminant validity tests showed that EMA VWM was not linked with laboratory scores of verbal abilities and processing speed. These data provide initial evidence on the convergent and discriminant validity of interpretations from this novel, ecologically valid neurocognitive approach. Future studies will aim to further establish the psychometric properties of this (and similar) tasks and investigate how momentary fluctuations in VWM correspond with contextual influences (e.g., substance use, mood) and clinical outcomes.

Schüz, Benjamin; Bower, Jodie; Ferguson, Stuart G. (2015): Stimulus control and affect in dietary behaviours. An intensive longitudinal study. In: Appetite 87, S. 310–317. DOI: 10.1016/j.appet.2015.01.002.

Background: Dietary behaviours are substantially influenced by environmental and internal stimuli, such as mood, social situation, and food availability. However, little is known about the role of stimulus control for eating in non-clinical populations, and no studies so far have looked at eating and drinking behaviour simultaneously. Method: 53 individuals from the general population took part in an intensive longitudinal study with repeated, real-time assessments of eating and drinking using Ecological Momentary Assessment. Eating was assessed as main meals and snacks, drinks assessments were separated along alcoholic and non-alcoholic drinks. Situational and internal stimuli were assessed during both eating and drinking events, and during randomly selected non-eating occasions. Hierarchical multinomial logistic random effects models were used to analyse data, comparing dietary events to non-eating occasions. Results: Several situational and affective antecedents of dietary behaviours could be identified. Meals were significantly associated with having food available and observing others eat. Snacking was associated with negative affect, having food available, and observing others eat. Engaging in activities and being with others decreased the likelihood of eating behaviours. Non-alcoholic drinks were associated with observing others eat, and less activities and company. Alcoholic drinks were associated with less negative affect and arousal, and with observing others eat. Conclusions: Results support the role of stimulus control in dietary behaviours, with support for both internal and external, in particular availability and social stimuli. The findings for negative affect support the idea of comfort eating, and results point to the formation of eating habits via cue–behaviour associations.

Sheets, Erin S.; Bujarski, Spencer; Leventhal, Adam M.; Ray, Lara A. (2015): Emotion differentiation and intensity during acute tobacco abstinence: A comparison of heavy and light smokers. In: Addict Behav 47, S. 70–73. DOI: 10.1016/j.addbeh.2015.03.024.

The ability to recognize and label discrete emotions, termed emotion differentiation, is particularly pertinent to overall emotion regulation abilities. Patterns of deficient emotion differentiation have been associated with mood and anxiety disorders but have yet to be examined in relation to nicotine dependence. This study employed ecological momentary assessment to examine smokers’ subjective experience of discrete emotions during 24-h of forced tobacco abstinence. Thirty daily smokers rated their emotions up to 23 times over the 24-hour period, and smoking abstinence was biologically verified. From these data, we computed individual difference measures of emotion differentiation, overall emotion intensity, and emotional variability. As hypothesized, heavy smokers reported poorer negative emotion differentiation than light smokers (d=0.55), along with more intense negative emotion (d=0.97) and greater negative emotion variability (d=0.97). No differences were observed in positive emotion differentiation. Across the sample, poorer negative emotion differentiation was associated with greater endorsement of psychological motives to smoke, including negative and positive reinforcement motives, while positive emotion differentiation was not.

Sheinbaum, Tamara; Kwapil, Thomas R.; Ballespi, Sergi; Mitjavila, Merce; Chun, Charlotte A.; Silvia, Paul J.; Barrantes-Vidal, Neus (2015): Attachment style predicts affect, cognitive appraisals, and social functioning in daily life. In: Front Psychol 6, S. 296. DOI: 10.3389/fpsyg.2015.00296.

The way in which attachment styles are expressed in the moment as individuals navigate their real-life settings has remained an area largely untapped by attachment research. The present study examined how adult attachment styles are expressed in daily life using experience sampling methodology (ESM) in a sample of 206 Spanish young adults. Participants were administered the Attachment Style Interview (ASI) and received personal digital assistants that signaled them randomly eight times per day for 1 week to complete questionnaires about their current experiences and social context. As hypothesized, participants’ momentary affective states, cognitive appraisals, and social functioning varied in meaningful ways as a function of their attachment style. Individuals with an anxious attachment, as compared with securely attached individuals, endorsed experiences that were congruent with hyperactivating tendencies, such as higher negative affect, stress, and perceived social rejection. By contrast, individuals with an avoidant attachment, relative to individuals with a secure attachment, endorsed experiences that were consistent with deactivating tendencies, such as decreased positive states and a decreased desire to be with others when alone. Furthermore, the expression of attachment styles in social contexts was shown to be dependent upon the subjective appraisal of the closeness of social contacts, and not merely upon the presence of social interactions. The findings support the ecological validity of the ASI and the person-by-situation character of attachment theory. Moreover, they highlight the utility of ESM for investigating how the predictions derived from attachment theory play out in the natural flow of real life.

Sherman, Ryne A.; Rauthmann, John F.; Brown, Nicolas A.; Serfass, David G.; Jones, Ashley Bell (2015): The Independent Effects of Personality and Situations on Real-Time Expressions of Behavior and Emotion. In: J Pers Soc Psychol. DOI: 10.1037/pspp0000036.

The joint influence of persons and situations on behavior has long been posited by personality and social psychological theory (Funder, 2006; Lewin, 1951). However, a lack of tools for real-time behavioral and situation assessment has left direct investigations of this sort immobilized. This study combines recent advances in situation assessment and experience sampling methodology to examine the simultaneous effects of personality traits and situation characteristics on real-time expressions of behavior and emotion in N = 210 participants. The results support an additive model such that both personality traits and situation characteristics independently predict real-time expressions of behavior and emotion. These results have implications for several prominent theoretical perspectives in personality, including both trait and cognitive theories.

Shiffman, Saul; Dunbar, Michael S.; Tindle, Hilary A.; Ferguson, Stuart G. (2015): Nondaily Smokers’ Experience of Craving on Days They Do Not Smoke. In: J Abnorm Psychol. DOI: 10.1037/abn0000063.

Nondaily, or intermittent smokers (ITS), represent a growing pattern in adult smoking that needs to be explained by models of drug dependence. ITS regularly and voluntarily abstain from smoking, yet have difficulty quitting. We examine potential accounts of ITS’ smoking by exploring their experience of craving and withdrawal on the days they abstain. For 3 weeks, 146 ITS and 194 daily smokers used the Ecological Momentary Assessment (EMA) to monitor craving, withdrawal, and smoking in real-time. ITS’ craving (p < .001) and arousal (p < .001) were significantly lower on the 34.4% of days when they abstained (compared with days they smoked), and they experienced no increases in withdrawal symptoms. ITS who abstained for longer experienced lower craving, even on their first day of abstinence (p < .001). Within strata defined by longest duration of abstinence (1, 2-3, 4-6, >/=7 days), craving did not change over time, demonstrating no increase as resumption of smoking approached. Craving increased only at the moment smoking resumed. Furthermore, duration of abstinence runs varied more within persons than across persons. These findings contradict the predictions of a model positing that craving recurs at fixed intervals. Findings are consistent with the hypothesis that ITS’ smoking is cued or primed by particular stimuli rather than by temporal cycles. These analyses demonstrate that ITS do not experience increased craving or withdrawal on days they do not smoke, and show neither signs of classical dependence nor regular cycles of craving and smoking.

Sims, Tamara; Tsai, Jeanne L.; Jiang, Da; Wang, Yaheng; Fung, Helene H.; Zhang, Xiulan (2015): Wanting to Maximize the Positive and Minimize the Negative: Implications for Mixed Affective Experience in American and Chinese Contexts. In: J Pers Soc Psychol. DOI: 10.1037/a0039276.

Previous studies have demonstrated that European Americans have fewer mixed affective experiences (i.e., are less likely to experience the bad with the good) compared with Chinese. In this article, we argue that these cultural differences are due to “ideal affect,” or how people ideally want to feel. Specifically, we predict that people from individualistic cultures want to maximize positive and minimize negative affect more than people from collectivistic cultures, and as a result, they are less likely to actually experience mixed emotions (reflected by a more negative within-person correlation between actual positive and negative affect). We find support for this prediction in 2 experience sampling studies conducted in the United States and China (Studies 1 and 2). In addition, we demonstrate that ideal affect is a distinct construct from dialectical view of the self, which has also been related to mixed affective experience (Study 3). Finally, in Study 4, we demonstrate that experimentally manipulating the desire to maximize the positive and minimize the negative alters participants’ actual experience of mixed emotions during a pleasant (but not unpleasant or combined pleasant and unpleasant) TV clip in the United States and Hong Kong. Together, these findings suggest that across cultures, how people want to feel shapes how they actually feel, particularly people’s experiences of mixed affect.

Snir, Avigal; Rafaeli, Eshkol; Gadassi, Reuma; Berenson, Kathy; Downey, Geraldine (2015): Explicit and Inferred Motives for Nonsuicidal Self-Injurious Acts and Urges in Borderline and Avoidant Personality Disorders. In: Personal Disord. DOI: 10.1037/per0000104.

Nonsuicidal self-injury (NSSI) is a perplexing phenomenon that may have differing motives. The present study used experience sampling methods (ESM) which inquired explicitly about the motives for NSSI, but also enabled a temporal examination of the antecedents/consequences of NSSI; these allow us to infer other motives which were not explicitly endorsed. Adults (n = 152, aged 18-65) with borderline personality disorder (BPD), avoidant personality disorder (APD), or no psychopathology participated in a 3-week computerized diary study. We examined 5 classes of explicit motives for engaging in NSSI, finding support primarily for internally directed rather than interpersonally directed ones. We then used multilevel regression to examine changes in affect, cognition, and behavior surrounding moments of NSSI acts/urges compared with control moments (i.e., without NSSI). We examined changes in 5 scales of inferred motives, designed to correspond to the 5 classes of explicit motives. The results highlight differing motives for NSSI among individuals with BPD and APD, with some similarities (mostly in the explicit motives) and some differences (mostly in the inferred motives) between the disorders. Despite their infrequent explicit endorsement, fluctuations in interpersonally oriented scales were found surrounding NSSI acts/urges. This highlights the need to continue attending to interpersonal aspects of NSSI in research and in clinical practice. Additionally, NSSI urges, like acts, were followed by decline in affective/interpersonal distress (although in a delayed manner). Thus, interventions that build distress tolerance and enhance awareness for affective changes, and for antecedent/consequence patterns in NSSI, could help individuals resist the urge to self-injure.

Solymosi, Reka; Bowers, Kate; Fujiyama, Taku (2015): Mapping fear of crime as a context‐dependent everyday experience that varies in space and time. In: Legal and Criminological Psychology. DOI: 10.1111/lcrp.12076.

Purpose There is a current need for innovation in research on the fear of crime to move on from general and static representations and instead approach it as a dynamic phenomenon experienced in everyday life, to inform or evaluate situational interventions. Methods This study presents a novel approach to fear of crime research using the framework of routine activities theory and environmental criminology to present it as a specific event characterized by spatial, temporal, and personal variables. We suggest and illustrate a new experience sampling approach to data collection, captured via a mobile phone application. Results By studying the fear of crime in the environment where it occurs, and focusing on a microscale geography with the additional dimension of time, new insight into fear of crime can be attained. Results from a data collection pilot demonstrate significant spatiotemporal variation in individuals’ fear of crime levels and hence illustrate the viability of such approaches. Conclusions We argue that this new insight can lead to the development of situational interventions which target fear of crime hot spots as they move about in place and time, allowing limited resources to be allocated more efficiently to enhance perceptions of safety.

Soong, Andrea; Chen, Julia Cen; Borzekowski, Dina Lg (2015): Using Ecological Momentary Assessment to Study Tobacco Behavior in Urban India: There’s an App for That. In: JMIR Res Protoc 4 (2), S. e76. DOI: 10.2196/resprot.4408.

BACKGROUND: Ecological momentary assessment (EMA) uses real-time data collection to assess participants’ behaviors and environments. This paper explores the strengths and limitations of using EMA to examine social and environmental exposure to tobacco in urban India among older adolescents and adults. OBJECTIVE: Objectives of this study were (1) to describe the methods used in an EMA study of tobacco use in urban India using a mobile phone app for data collection, (2) to determine the feasibility of using EMA in the chosen setting by drawing on participant completion and compliance rates with the study protocol, and (3) to provide recommendations on implementing mobile phone EMA research in India and other low- and middle-income countries. METHODS: Via mobile phones and the Internet, this study used two EMA surveys: (1) a momentary survey, sent multiple times per day at random to participants, which asked about their real-time tobacco use (smoked and smokeless) and exposure to pro- and antitobacco messaging in their location, and 2) an end-of-day survey sent at the end of each study day. Trained participants, from Hyderabad and Kolkata, India, reported on their social and environmental exposure to tobacco over 10 consecutive days. This feasibility study examined participant compliance, exploring factors related to the successful completion of surveys and the validity of EMA data. RESULTS: The sample included 205 participants, the majority of whom were male (135/205, 65.9%). Almost half smoked less than daily (56/205, 27.3%) or daily (43/205, 21.0%), and 4.4% (9/205) used smokeless tobacco products. Participants completed and returned 46.87% and 73.02% of momentary and end-of-day surveys, respectively. Significant predictors of momentary survey completion included employment and completion of end-of-day surveys. End-of-day survey completion was only significantly predicted by momentary survey completion. CONCLUSIONS: This first study of EMA in India offers promising results, although more research is needed on how to increase compliance. End-of-day survey completion, which has a lower research burden, may be the more appropriate approach to understanding behaviors such as tobacco use within vulnerable populations in challenging locations. Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection.

Spangenberg, Lena; Forkmann, Thomas; Glaesmer, Heide (2015): Investigating dynamics and predictors of suicidal behaviors using ambulatory assessment. In: Neuropsychiatr. DOI: 10.1007/s40211-015-0142-1.

Ambulatory assessment studies may provide important insights in the etiology of suicidal behaviors, because suicidal behaviors and their risk factors fluctuate over time.The review aims at (1) evaluating the current state of research and (2) summarizing main findings in this field. Reviewed studies (N = 4) were heterogeneous. Up to 74 % of participants reported suicidal ideation during ambulatory assessment sampling. Suicidal ideation was predicted by intensity and instability of negative affective states (e.g., worry, sadness). Ambulatory assessment studies seem a promising approach to uncover the dynamic course of suicidal ideation and its risk factors in clinically relevant time frames (i.e., real-time).

Steinhubl, Steven R.; Muse, Evan D.; Topol, Eric J. (2015): The emerging field of mobile health. In: Sci Transl Med 7 (283), S. 283rv3. DOI: 10.1126/scitranslmed.aaa3487.

The surge in computing power and mobile connectivity have fashioned a foundation for mobile health (mHealth) technologies that can transform the mode and quality of clinical research and health care on a global scale. Unimpeded by geographical boundaries, smartphone-linked wearable sensors, point-of-need diagnostic devices, and medical-grade imaging, all built around real-time data streams and supported by automated clinical decision-support tools, will enable care and enhance our understanding of physiological variability. However, the path to mHealth incorporation into clinical care is fraught with challenges. We currently lack high-quality evidence that supports the adoption of many new technologies and have financial, regulatory, and security hurdles to overcome. Fortunately, sweeping efforts are under way to establish the true capabilities and value of the evolving mHealth field.

Stieger, Stefan; Gotz, Friedrich M.; Gehrig, Fabienne (2015): Soccer results affect subjective well-being, but only briefly: a smartphone study during the 2014 FIFA World Cup. In: Front Psychol 6, S. 497. DOI: 10.3389/fpsyg.2015.00497.

The current research examined the effects of soccer match results on spectators’ subjective well-being. Across the group stage of the soccer World Cup 2014, German-speaking participants indicated their well-being three times per day through a smartphone-based science app. In line with proposed hypotheses, comparisons of data taken after the three matches of the German national team showed robust effects, revealing that well-being was higher among spectators than non-spectators, with effects increasing as a function of goal difference. Moreover, this gain in well-being was only found in spectators supporting the German soccer team, allowing us to rule out a general emotional contagion effect affecting all spectators. Although soccer results are associated with national identity and pride, their effects on subjective well-being were short-lived and only affected supporters.

Stoner, Susan A.; Arenella, Pamela B.; Hendershot, Christian S. (2015): Randomized controlled trial of a mobile phone intervention for improving adherence to naltrexone for alcohol use disorders. In: PLoS One 10 (4), S. e0124613. DOI: 10.1371/journal.pone.0124613.

BACKGROUND: Naltrexone is a front-line treatment for alcohol use disorders, but its efficacy is limited by poor medication adherence. This randomized controlled trial evaluated whether a mobile health intervention could improve naltrexone adherence. METHODS: Treatment-seeking participants with an alcohol use disorder (N = 76) were randomized to intervention and control conditions. All participants received naltrexone (50 mg/day) with a medication event monitoring system (MEMS) and a prepaid smartphone, and received a daily text message querying medication side effects, alcohol use, and craving. Those in the intervention arm received additional medication reminders and adherence assessment via text message. RESULTS: The primary outcome, proportion of participants with adequate adherence (defined as >/=80% of prescribed doses taken through Week 8), did not differ between groups in intent-to-treat analyses (p = .34). Mean adherence at study midpoint (Week 4) was 83% in the intervention condition and 77% in the control condition (p = .35). Survival analysis found that the intervention group sustained adequate adherence significantly longer (M = 19 days [95% CI = 0.0-44.0]) than those in the control group (M = 3 days [95% CI = 0.0-8.1]) during the first month of treatment (p = .04). Medication adherence did not predict drinking outcomes. CONCLUSIONS: These results suggest that in the context of daily monitoring and assessment via cell phone, additional text message reminders do not further improve medication adherence. Although this initial trial does not provide support for the efficacy of text messaging to improve adherence to pharmacotherapy for alcohol use disorders, additional trials with larger samples and alternate designs are warranted. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01349985.

Streb, Judith; Kammer, Thomas; Spitzer, Manfred; Hille, Katrin (2015): Extremely reduced motion in front of screens: investigating real-world physical activity of adolescents by accelerometry and electronic diary. In: PLoS One 10 (5), S. e0126722. DOI: 10.1371/journal.pone.0126722.

This paper reports accelerometer and electronic dairy data on typical daily activities of 139 school students from grade six and nine. Recordings covered a typical school day for each student and lasted on average for 23 h. Screen activities (watching television and using the computer) are compared to several other activities performed while sitting (e.g., playing, eating, sitting in school, and doing homework). Body movement was continuously recorded by four accelerometers and transformed into a motion sore. Our results show that extremely low motion scores, as if subjects were freezing, emerge to a greater extent in front of screens compared to other investigated activities. Given the substantial amount of time young people spend in front of screens and the rising obesity epidemic, our data suggest a mechanism for the association of screen time and obesity.

Thielsch, Carolin; Andor, Tanja; Ehring, Thomas (2015): Do metacognitions and intolerance of uncertainty predict worry in everyday life? An ecological momentary assessment study. In: Behavior Therapy. DOI: 10.1016/j.beth.2015.05.001.

Cognitive models of generalized anxiety disorder (GAD) suggest that excessive worry is due to positive and negative metacognitive beliefs and/or intolerance of uncertainty. Empirical support mainly derives from cross-sectional studies with limited conclusiveness, using self-report measures and thereby possibly causing recall biases. The aim of the present study therefore was to examine the power of these cognitive variables to predict levels of worry in everyday life using Ecological Momentary Assessment (EMA). Metacognitions and intolerance of uncertainty were assessed using well-established self-report questionnaires in 41 nonclinical participants who subsequently completed ratings on worry intensity and burden on a portable device for 1week at seven times a day once every 2hours. Results showed significant associations of negative metacognitive beliefs and intolerance of uncertainty, but not positive metacognitive beliefs, with worry in everyday life. In multilevel regression analyses, a substantial proportion of variance of everyday worry could be accounted for by negative metacognitions over and above trait worry and daily hassles. Intolerance of uncertainty likewise emerged as a valid predictor when tested in isolation, but did not explain additional variance once negative metacognitions were controlled. The findings support current cognitive models of excessive worry and highlight the role of negative metacognitions. By using EMA to assess levels of worry in everyday life, they extend earlier findings focusing exclusively on retrospective questionnaire measures.

Thielsch, Carolin; Ehring, Thomas; Nestler, Steffen; Wolters, Janina; Kopei, Ina; Rist, Fred et al. (2015): Metacognitions, worry and sleep in everyday life: Studying bidirectional pathways using Ecological Momentary Assessment in GAD patients. In: J Anxiety Disord 33, S. 53–61. DOI: 10.1016/j.janxdis.2015.04.007.

BACKGROUND: The metacognitive model of generalized anxiety disorder proposes that negative metacognitive beliefs are crucial in the maintenance of excessive worry. Furthermore, according to the cognitive model of insomnia, worry leads to problems falling or staying asleep and poor sleep quality. In order to test the assumed causal relationships, the present study examined the time-dependent course of negative metacognition and worry as well as worry and sleep quality, using Ecological Momentary Assessment (EMA). METHOD: Negative metacognitions, worry and sleep were assessed by self-report questionnaires as well as EMA in 56 GAD patients who carried a portable device for 1 week and logged sleep quality, negative metacognition and worry processes four times a day. RESULTS: Metacognitions, worry and sleep were significantly correlated. Structural equation modeling using multilevel analyses showed a unidirectional relationship of negative metacognitions leading to prolonged worry processes and a bidirectional relationship of worry and sleep quality. CONCLUSIONS: These findings support the theoretically derived assumptions on the relationship between negative metacognitions, worry and sleep. Implications for further research as well as clinical implications are discussed.

Thompson, Renee J.; Kuppens, Peter; Mata, Jutta; Jaeggi, Susanne M.; Buschkuehl, Martin; Jonides, John; Gotlib, Ian H. (2015): Emotional Clarity as a Function of Neuroticism and Major Depressive Disorder. In: Emotion. DOI: 10.1037/emo0000067.

Investigators have begun to document links between emotional clarity and forms of negative emotionality, including neuroticism and major depressive disorder (MDD). Researchers to date have relied almost exclusively on global self-reports of emotional clarity; moreover, no studies have examined emotional clarity as a function of valence, although this may prove to be crucial in understanding the relation of emotional clarity to maladjustment. In 2 studies, we used experience-sampling methodology and multilevel modeling to examine the associations between emotional clarity and 2 constructs that have been linked theoretically with emotional clarity: neuroticism and depression. In Study 1 we assessed 95 college students who completed a self-report measure of neuroticism. In Study 2 we examined 53 adults diagnosed with MDD and 53 healthy adults. Reaction times to negative and positive emotion ratings during the experience-sampling protocols were used as an indirect measure of emotional clarity. Neuroticism was related to lower clarity of negative, but not of positive, emotion. Similarly, compared with the healthy controls, individuals with MDD had lower clarity of negative, but not of positive, emotion. It is important to note, findings from both studies held after controlling for baseline RTs and current levels of negative and positive emotion. These findings highlight the importance of assessing valence when examining emotional clarity and increase our understanding of the nature of the emotional disturbances that characterize neuroticism and MDD.

Timmerman, J. G.; Weering, M. G. H. Dekker-van; Tönis, T. M.; Hermens, H. J.; Vollenbroek-Hutten, M. M. R. (2015): Relationship between patterns of daily physical activity and fatigue in cancer survivors. In: European Journal of Oncology Nursing 19 (2), S. 162–168. DOI: 10.1016/j.ejon.2014.09.005.

Purpose: This study investigated: (1) physical activity behaviour of cancer survivors throughout the day, (2) the relationship between objective and subjective measures of physical activity, and (3) the relationship between daily physical activity and fatigue. Method: Physical activity was measured objectively using 3D-accelerometry (expressed in counts per minute (cpm)), and subjectively using a Visual Analogue Scale (VAS; 0–10) implemented on a smartphone in 18 cancer survivors (6 male; age 55.7 ± 10.2 yrs; free from cancer, last treatment ≥three months previously), and matched controls. Fatigue was scored thrice daily on a smartphone (0-10 VAS). Results: Mean daily physical activity of cancer survivors did not deviate from controls (1108 ± 287 cpm versus 1223 ± 371 cpm, p = .305). However, in cancer survivors physical activity significantly decreased from morning to evening (p < .01) and increased levels of fatigue throughout the day were reported (p < .01). Furthermore, a positive correlation was found between levels of fatigue and the magnitude of the decline in physical activity from afternoon to evening (p < .05). Objective and subjective measured physical activity showed low correlations. Conclusions: This study demonstrated imbalanced activity patterns in cancer survivors. Also, the more a survivor felt fatigued, the greater the decline in activity behaviour throughout the day. The low correlation between objective and subjective physical activity suggests low awareness in cancer survivors about their daily physical activity performed. Ambulatory monitoring provides new insights in both patterns of physical activity and fatigue, which might be a valuable tool to provide activity management more efficiently during treatment of fatigue.

Tivesten, Emma; Dozza, Marco (2015): Driving context influences drivers’ decision to engage in visual–manual phone tasks: Evidence from a naturalistic driving study. In: Journal of Safety Research 53, S. 87–96. DOI: 10.1016/j.jsr.2015.03.010.

Introduction: Visual–manual (VM) phone tasks (i.e., texting, dialing, reading) are associated with an increased crash/near-crash risk. This study investigated how the driving context influences drivers’ decisions to engage in VM phone tasks in naturalistic driving. Method: Video-recordings of 1,432 car trips were viewed to identify VM phone tasks and passenger presence. Video, vehicle signals, and map data were used to classify driving context (i.e., curvature, other vehicles) before and during the VM phone tasks (N=374). Vehicle signals (i.e., speed, yaw rate, forward radar) were available for all driving. Results: VM phone tasks were more likely to be initiated while standing still, and less likely while driving at high speeds, or when a passenger was present. Lead vehicle presence did not influence how likely it was that a VM phone task was initiated, but the drivers adjusted their task timing to situations when the lead vehicle was increasing speed, resulting in increasing time headway. The drivers adjusted task timing until after making sharp turns and lane change maneuvers. In contrast to previous driving simulator studies, there was no evidence of drivers reducing speed as a consequence of VM phone task engagement. Conclusions: The results show that experienced drivers use information about current and upcoming driving context to decide when to engage in VM phone tasks. However, drivers may fail to sufficiently increase safety margins to allow time to respond to possible unpredictable events (e.g., lead vehicle braking). Practical applications: Advanced driver assistance systems should facilitate and possibly boost drivers’ self-regulating behavior. For instance, they might recognize when appropriate adaptive behavior is missing and advise or alert accordingly. The results from this study could also inspire training programs for novice drivers, or locally classify roads in terms of the risk associated with secondary task engagement while driving.

Tobin, Erin T.; Kane, Heidi S.; Saleh, Daniel J.; Naar-King, Sylvie; Poowuttikul, Pavadee; Secord, Elizabeth et al. (2015): Naturalistically observed conflict and youth asthma symptoms. In: Health Psychology 34 (6), S. 622–631. DOI: 10.1037/hea0000138.

Objective: To investigate the links between naturalistically observed conflict, self-reported caregiver−youth conflict, and youth asthma symptoms. Method: Fifty-four youth with asthma (age range: 10–17 years) wore the Electronically Activated Recorder (EAR) for a 4-day period to assess interpersonal conflict and caregiver−youth conflict as they occur in daily life. Conflict also was assessed with baseline self-report questionnaires and daily diaries completed by youth participants and their caregivers. Asthma symptoms were assessed using daily diaries, baseline self-reports, and wheezing, as coded from the EAR. Results: EAR-observed measures of conflict were strongly associated with self-reported asthma symptoms (both baseline and daily diaries) and wheezing coded from the EAR. Further, when entered together in regression analyses, youth daily reports of negative caregiver−youth interactions and EAR-observed conflict uniquely predicted asthma symptoms; only EAR-observed conflict was associated with EAR-observed wheezing. Conclusion: These findings demonstrate the potential impact of daily conflict on youth asthma symptoms and the importance of assessing conflict as it occurs in everyday life. More broadly, they point to the importance of formulating a clear picture of family interactions outside of the lab, which is essential for understanding how family relationships “get under the skin” to affect youth health.

Torous, John; Staples, Patrick; Onnela, Jukka-Pekka (2015): Realizing the Potential of Mobile Mental Health: New Methods for New Data in Psychiatry. In: Curr Psychiatry Rep 17 (8), S. 602. DOI: 10.1007/s11920-015-0602-0.

Smartphones are now ubiquitous and can be harnessed to offer psychiatry a wealth of real-time data regarding patient behavior, self-reported symptoms, and even physiology. The data collected from smartphones meet the three criteria of big data: velocity, volume, and variety. Although these data have tremendous potential, transforming them into clinically valid and useful information requires using new tools and methods as a part of assessment in psychiatry. In this paper, we introduce and explore numerous analytical methods and tools from the computational and statistical sciences that appear readily applicable to psychiatric data collected using smartphones. By matching smartphone data with appropriate statistical methods, psychiatry can better realize the potential of mobile mental health and empower both patients and providers with novel clinical tools.

Treloar, Hayley; Piasecki, Thomas M.; McCarthy, Denis M.; Sher, Kenneth J.; Heath, Andrew C. (2015): Ecological evidence that affect and perceptions of drink effects depend on alcohol expectancies. In: Addiction. DOI: 10.1111/add.12982.

AIMS: (1) To compare affective changes over drinking and non-drinking days among frequent drinkers and (2) to evaluate whether drinkers’ expectations influence affective changes and perceived pleasure and relief from drinking. DESIGN: Observational study involving ecological momentary assessments collected via electronic diaries during the course of 3 weeks. SETTING: Drinkers’ usual settings in Columbia, MO, USA. PARTICIPANTS: A total of 400 adult, frequent drinkers, aged 18-70 years. MEASUREMENTS: Ecological assessments included morning reports, pre-drinking random prompts, user-initiated first-drink reports and device-prompted follow-ups over drinking episodes. Participants rated positive (enthusiastic, excited, happy) and negative (distressed, sad) affect and perceived pleasure and relief from drinking in real time. A self-report questionnaire completed at baseline evaluated expectancies for enhanced sociability and tension reduction from drinking. FINDINGS: Relative to affective changes over non-drinking days, positive affect increased prior to drinking [95% confidence interval (CI) = 0.004, 0.023], and at first drink (95% CI = 0.238, 0.317), whereas negative affect decreased prior to drinking (95% CI = – 0.007, 0.000) and at first drink (95% CI = – 0.154, – 0.098). Sociability expectancies augmented increases in positive affect prior to drinking (95% CI = 0.009, 0.027) and at first drink (95% CI = 0.017, 0.169). Sociability expectancies also enhanced perceived pleasure from first drinks (95% CI = 0.046, 0.318). Tension-reduction expectancies attenuated decreases in negative affect at first drink (95% CI = – 0.133, – 0.029), but augmented perceived relief from first drinks (95% CI = 0.001, 0.304). CONCLUSIONS: Although theoretical models tend to focus on negative affective outcomes of drinking, changes in positive affect prior to drinking and early in drinking episodes are important for maintaining drinking behavior. Frequent drinkers’ expectations for enhanced sociability or tension reduction from drinking influence their affective experiences over drinking days and perceptions of pleasure and relief from drinking.

Trivedi, Daksha (2015): Cochrane review summary: Smartphone and tablet self-management apps for asthma. In: Primary Health Care Research and Development 16 (2), S. 111–113. DOI: 10.1017/S1463423615000018.

This Cochrane review examines whether smartphone and tablet computer apps are feasible, effective and cost-effective tools for the self-management of individuals with asthma. Included studies had to use a health app as the only means of delivering the intervention or where apps formed a part of a composite intervention. Interventions needed to be compared with other self-management interventions delivered using traditional or alternative methods (eg, paper-based diaries for asthma management). Of the two studies analyzed, one found no statistically significant difference in Asthma Control Questionnaire scores between the intervention and control groups at six months. One showed no evidence of effect on unscheduled visits to ED and in the other study, intervention participants were less likely to attend the ED than the control group. There was no evidence of any significant effect on adherence to intervention. However, a significant effect was reported on total health-care costs. Use of smartphone apps in self-management of asthma is in its infancy. Patients reported good compliance and such devices have the potential to make self-management interventions more accessible and convenient. However, methodological limitations and contradictory findings from only two studies suggest inadequate evidence to recommend their use in routine care.

Tudor-Locke, Catrine; Barreira, Tiago V.; Schuna, John M Jr; Mire, Emily F.; Chaput, Jean-Philippe; Fogelholm, Mikael et al. (2015): Improving wear time compliance with a 24-hour waist-worn accelerometer protocol in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). In: Int J Behav Nutr Phys Act 12, S. 11. DOI: 10.1186/s12966-015-0172-x.

BACKGROUND: We compared 24-hour waist-worn accelerometer wear time characteristics of 9-11 year old children in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) to similarly aged U.S. children providing waking-hours waist-worn accelerometer data in the 2003-2006 National Health and Nutrition Examination Survey (NHANES). METHODS: Valid cases were defined as having >/=4 days with >/=10 hours of waking wear time in a 24-hour period, including one weekend day. Previously published algorithms for extracting total sleep episode time from 24-hour accelerometer data and for identifying wear time (in both the 24-hour and waking-hours protocols) were applied. The number of valid days obtained and a ratio (percent) of valid cases to the number of participants originally wearing an accelerometer were computed for both ISCOLE and NHANES. Given the two surveys’ discrepant sampling designs, wear time (minutes/day, hours/day) from U.S. ISCOLE was compared to NHANES using a meta-analytic approach. Wear time for the 11 additional countries participating in ISCOLE were graphically compared with NHANES. RESULTS: 491 U.S. ISCOLE children (9.92+/-0.03 years of age [M+/-SE]) and 586 NHANES children (10.43 +/- 0.04 years of age) were deemed valid cases. The ratio of valid cases to the number of participants originally wearing an accelerometer was 76.7% in U.S. ISCOLE and 62.6% in NHANES. Wear time averaged 1357.0 +/- 4.2 minutes per 24-hour day in ISCOLE. Waking wear time was 884.4 +/- 2.2 minutes/day for U.S. ISCOLE children and 822.6 +/- 4.3 minutes/day in NHANES children (difference = 61.8 minutes/day, p < 0.001). Wear time characteristics were consistently higher in all ISCOLE study sites compared to the NHANES protocol. CONCLUSIONS: A 24-hour waist-worn accelerometry protocol implemented in U.S. children produced 22.6 out of 24 hours of possible wear time, and 61.8 more minutes/day of waking wear time than a similarly implemented and processed waking wear time waist-worn accelerometry protocol. Consistent results were obtained internationally. The 24-hour protocol may produce an important increase in wear time compliance that also provides an opportunity to study the total sleep episode time separate and distinct from physical activity and sedentary time detected during waking-hours. TRIAL REGISTRATION: ClinicalTrials.gov NCT01722500 .

Van Stan, Jarrad H; Mehta, Daryush D.; Zeitels, Steven M.; Burns, James A.; Barbu, Anca M.; Hillman, Robert E. (2015): Average Ambulatory Measures of Sound Pressure Level, Fundamental Frequency, and Vocal Dose Do Not Differ Between Adult Females With Phonotraumatic Lesions and Matched Control Subjects. In: Ann Otol Rhinol Laryngol. DOI: 10.1177/0003489415589363.

OBJECTIVES: Clinical management of phonotraumatic vocal fold lesions (nodules, polyps) is based largely on assumptions that abnormalities in habitual levels of sound pressure level (SPL), fundamental frequency (f0), and/or amount of voice use play a major role in lesion development and chronic persistence. This study used ambulatory voice monitoring to evaluate if significant differences in voice use exist between patients with phonotraumatic lesions and normal matched controls. METHODS: Subjects were 70 adult females: 35 with vocal fold nodules or polyps and 35 age-, sex-, and occupation-matched normal individuals. Weeklong summary statistics of voice use were computed from anterior neck surface acceleration recorded using a smartphone-based ambulatory voice monitor. RESULTS: Paired t tests and Kolmogorov-Smirnov tests resulted in no statistically significant differences between patients and matched controls regarding average measures of SPL, f0, vocal dose measures, and voicing/voice rest periods. Paired t tests comparing f0 variability between the groups resulted in statistically significant differences with moderate effect sizes. CONCLUSIONS: Individuals with phonotraumatic lesions did not exhibit differences in average ambulatory measures of vocal behavior when compared with matched controls. More refined characterizations of underlying phonatory mechanisms and other potentially contributing causes are warranted to better understand risk factors associated with phonotraumatic lesions.

van Winkel, M.; Nicolson, N. A.; Wichers, M.; Viechtbauer, W.; Myin-Germeys, I.; Peeters, F. (2015): Daily life stress reactivity in remitted versus non-remitted depressed individuals. In: Eur Psychiatry 30 (4), S. 441–447. DOI: 10.1016/j.eurpsy.2015.02.011.

BACKGROUND: Little is known about how daily life mood reactivity to minor stressors (stress reactivity) might change following major depressive disorder (MDD) treatment. We investigate whether (i) mood states and appraisals of daily stressors change after treatment; (ii) stress reactivity to event, activity, or social stress differs; (iii) stress reactivity depends on severity of residual depressive symptoms; and (iv) stress reactivity in individuals with remitted or non-remitted depression differ from that of never-depressed individuals. METHODS: Thirty depressed individuals participated in an experience sampling study before and after a treatment period of 18 months; 39 healthy individuals formed a comparison group. Reactivity of positive affect (PA) and negative affect (NA) to daily stressors were measured. RESULTS: More residual symptoms were associated with larger NA responses to stress. Compared to healthy controls, participants with non-remitted MDD showed higher NA-reactivity to all stressors. In contrast, stress reactivity to event and activity stressors was normalized in remitted patients. However, they still showed heightened NA-reactivity to social stress. CONCLUSIONS: Greater stress reactivity to event and activity stress appears to be state-dependent. The heightened social stress reactivity in remitted patients suggests that sensitivity to social stress may reflect an underlying vulnerability in MDD.

Verkuil, Bart; Brosschot, Jos F.; Gebhardt, Winifred A.; Korrelboom, Kees (2015): Goal linking and everyday worries in clinical work stress: A daily diary study. In: Br J Clin Psychol. DOI: 10.1111/bjc.12083.

OBJECTIVES: In this study, we tested whether high levels of daily worrying are associated with linking, a tendency to overvalue the attainment of specific lower level goals for attaining higher level goals, and more specifically the attainment of experiencing happiness. METHODS: Thirty-two patients suffering from work stress complaints and awaiting a stress management treatment and 31 healthy adults, who formed the comparison group, filled in a goal linking questionnaire and two widely used trait worry questionnaires. Subsequently, they reported the frequency and duration of worry during 14 consecutive days and nights. RESULTS: The patients suffering from work stress complaints scored higher on the linking questionnaire and worried almost twice as much as the healthy comparison group, especially during the night-time. Furthermore, goal linking was a stronger predictor of the frequency and duration of worry in daily life than the trait worry questionnaires and this was independent of the observed group differences in daily worry. CONCLUSIONS: These findings provide evidence that people who believe that their happiness is strongly dependent on the attainment of specific lower level goals worry frequently in daily life. Linking seems to be at least partly responsible for the excessive worry found in high work stress. PRACTITIONER POINTS: Worry is elevated in patients seeking professional help for work stress complaints, compared to healthy controls The higher levels of worry in the patient group were related to elevated tendencies to overvalue the attainment of specific lower level goals as a means to attain higher level goals (‘linking’). It could be beneficial for high worriers to learn how to reduce linking tendencies. No strong inferences on the direction of the association between worry and linking can be made, as we relied on correlational data in which a linking questionnaire predicted worry in daily life.

Wichers, Marieke; Kasanova, Zuzana; Bakker, Jindra; Thiery, Evert; Derom, Catherine; Jacobs, Nele; van Os, Jim (2015): From Affective Experience to Motivated Action: Tracking Reward-Seeking and Punishment-Avoidant Behaviour in Real-Life. In: PLoS One 10 (6), S. e0129722. DOI: 10.1371/journal.pone.0129722.

Many of the decisions and actions in everyday life result from implicit learning processes. Important to psychopathology are, for example, implicit reward-seeking and punishment-avoidant learning processes. It is known that when specific actions get associated with a rewarding experience, such as positive emotions, that this will increase the likelihood that an organism will engage in similar actions in the future. Similarly, when actions get associated with punishing experiences, such as negative emotions, this may reduce the likelihood that the organism will engage in similar actions in the future. This study examines whether we can observe these implicit processes prospectively in the flow of daily life. If such processes take place then we expect that current behaviour can be predicted by how similar behaviour was experienced (in terms of positive and negative affect) at previous measurement moments. This was examined in a sample of 621 female individuals that had participated in an Experience Sampling data collection. Measures of affect and behaviour were collected at 10 semi-random moments of the day for 5 consecutive days. It was examined whether affective experience that was paired with certain behaviours (physical activity and social context) at previous measurements modified the likelihood to show similar behaviours at next measurement moments. Analyses were performed both at the level of observations (a time scale with units of +/- 90 min) and at day level (a time scale with units of 24 h). As expected, we found that affect indeed moderated the extent to which previous behaviour predicted similar behaviour later in time, at both beep- and day-level. This study showed that it is feasible to track reward-seeking and punishment-avoidant behaviour prospectively in humans in the flow of daily life. This opens up a new toolbox to examine processes determining goal-oriented behaviour in relation to psychopathology in humans.

Wonderlich, Joseph A.; Lavender, Jason M.; Wonderlich, Stephen A.; Peterson, Carol B.; Crow, Scott J.; Engel, Scott G. et al. (2015): Examining convergence of retrospective and ecological momentary assessment measures of negative affect and eating disorder behaviors. In: International Journal of Eating Disorders 48 (3), S. 305–311. DOI: 10.1002/eat.22352.

Objective Data gathered via retrospective forms of assessment are subject to various recall biases. Ecological momentary assessment (EMA) is an alternative approach involving repeated momentary assessments within a participant’s natural environment, thus reducing recall biases and improving ecological validity. EMA has been used in numerous prior studies examining various constructs of theoretical relevance to eating disorders. Method: This investigation includes data from three previously published studies with distinct clinical samples: (a) women with anorexia nervosa (N = 118), (b) women with bulimia nervosa (N = 133), and (c) obese men and women (N = 50; 9 with current binge eating disorder). Each study assessed negative affective states and eating disorder behaviors using traditional retrospective assessments and EMA. Spearman rho correlations were used to evaluate the concordance of retrospective versus EMA measures of affective and/or behavioral constructs in each sample. Bland–Altman plots were also used to further evaluate concordance in the assessment of eating disorder behaviors. Results: There was moderate to strong concordance for the measures of negative affective states across all three studies. Moderate to strong concordance was also found for the measures of binge eating and exercise frequency. The strongest evidence of concordance across measurement approaches was found for purging behaviors. Discussion: Overall, these preliminary findings support the convergence of retrospective and EMA assessments of both negative affective states and various eating disorder behaviors. Given the advantages and disadvantages associated with each of these assessment approaches, the specific questions being studied in future empirical studies should inform decisions regarding selection of the most appropriate method.

Wray, Jennifer M.; Gray, Kevin M.; McClure, Erin A.; Carpenter, Matthew J.; Tiffany, Stephen T.; Saladin, Michael E. (2015): Gender differences in responses to cues presented in the natural environment of cigarette smokers. In: Nicotine & Tobacco Research 17 (4), S. 438–442. DOI: 10.1093/ntr/ntu248.

Introduction: Although the evidence is mixed, female smokers appear to have more difficulty quitting smoking than male smokers. Craving, stress, and negative affect have been hypothesized as potential factors underlying gender differences in quit rates. Methods: In the current study, the cue-reactivity paradigm was used to assess craving, stress, and negative affect in response to cues presented in the natural environment of cigarette smokers using ecological momentary assessment. Seventy-six daily smokers (42% female) responded to photographs (smoking, stress, and neutral) presented 4 times per day on an iPhone over the course of 2 weeks. Results: Both smoking and stress cues elicited stronger cigarette craving and stress responses compared to neutral cues. Compared with males, females reported higher levels of post-stress cue craving, stress, and negative affect, but response to smoking cues did not differ by gender. Discussion: Findings from this project were largely consistent with results from laboratory-based research and extend previous work by measuring response to cues in the natural environment of cigarette smokers. This study extends previous cue reactivity ecological momentary assessment research by using a new platform and by measuring response to stress cues outside of the laboratory. Findings from this project highlight the importance of addressing coping in response to stress cues in clinical settings, especially when working with female smokers.

Yang, Cui; Linas, Beth; Kirk, Gregory; Bollinger, Robert; Chang, Larry; Chander, Geetanjali et al. (2015): Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore. In: JMIR Mhealth Uhealth 3 (2), S. e67. DOI: 10.2196/mhealth.4344.

BACKGROUND: Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations. OBJECTIVE: We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore. METHODS: Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants’ location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants’ self-reported episodes of drinking. RESULTS: A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score >/=16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable. CONCLUSIONS: This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings.

Yuan, Shupei; Ma, Wenjuan; Kanthawala, Shaheen; Peng, Wei (2015): Keep Using My Health Apps: Discover Users’ Perception of Health and Fitness Apps with the UTAUT2 Model. In: Telemed J E Health. DOI: 10.1089/tmj.2014.0148.

BACKGROUND: Health and fitness applications (apps) are one of the major app categories in the current mobile app market. Few studies have examined this area from the users’ perspective. This study adopted the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2) Model to examine the predictors of the users’ intention to adopt health and fitness apps. MATERIALS AND METHODS: A survey (n=317) was conducted with college-aged smartphone users at a Midwestern university in the United States. RESULTS: Performance expectancy, hedonic motivations, price value, and habit were significant predictors of users’ intention of continued usage of health and fitness apps. However, effort expectancy, social influence, and facilitating conditions were not found to predict users’ intention of continued usage of health and fitness apps. CONCLUSIONS: This study extends the UTATU2 Model to the mobile apps domain and provides health professions, app designers, and marketers with the insights of user experience in terms of continuously using health and fitness apps.

Zedelius, Claire M.; Broadway, James M.; Schooler, Jonathan W. (2015): Motivating meta-awareness of mind wandering: A way to catch the mind in flight? In: Conscious Cogn 36, S. 44–53. DOI: 10.1016/j.concog.2015.05.016.

Given the negative effects of mind wandering on performance, it may be profitable to be aware of task-unrelated thoughts (TUTs) as they occur. The present study investigated whether motivating people to catch TUTs increases meta-awareness. We offered incentives for increased self-catching during reading. To enhance the veracity of these self-reports, we used a “bogus-pipeline” procedure; we convinced participants that their mental states were being covertly monitored using physiological measures. In reality, mind wandering was assessed covertly by a secondary task (“gibberish detection”), and overtly by experience sampling. The results showed that incentives increased the number of self-catches without increasing overall mind wandering. Moreover, both the bogus pipeline and the opportunity for incentives increased the validity of self-reports, evidenced by significantly increased correlations between self-caught and behaviorally assessed mind wandering. We discuss the relevance of this methodological approach for research on mind wandering and research building on introspective reports more generally.

Zhang, Weiyu; Yu, Qian; Siddiquie, Behjat; Divakaran, Ajay; Sawhney, Harpreet (2015): “Snap-n-Eat”: Food Recognition and Nutrition Estimation on a Smartphone. In: J Diabetes Sci Technol 9 (3), S. 525–533. DOI: 10.1177/1932296815582222.

We present snap-n-eat, a mobile food recognition system. The system can recognize food and estimate the calorific and nutrition content of foods automatically without any user intervention. To identify food items, the user simply snaps a photo of the food plate. The system detects the salient region, crops its image, and subtracts the background accordingly. Hierarchical segmentation is performed to segment the image into regions. We then extract features at different locations and scales and classify these regions into different kinds of foods using a linear support vector machine classifier. In addition, the system determines the portion size which is then used to estimate the calorific and nutrition content of the food present on the plate. Previous approaches have mostly worked with either images captured in a lab setting, or they require additional user input (eg, user crop bounding boxes). Our system achieves automatic food detection and recognition in real-life settings containing cluttered backgrounds. When multiple food items appear in an image, our system can identify them and estimate their portion size simultaneously. We implemented this system as both an Android smartphone application and as a web service. In our experiments, we have achieved above 85% accuracy when detecting 15 different kinds of foods.

Zheng, Yao; Cleveland, H. Harrington; Molenaar, Peter C. M.; Harris, Kitty S. (2015): An alternative framework to investigating and understanding intraindividual processes in substance abuse recovery: An idiographic approach and demonstration. In: Evaluation Review 39 (2), S. 229–254. DOI: 10.1177/0193841X14567313.

Background: Sustained recovery from substance abuse is a dynamic intraindividual-level process. Objectives: We argue that research on recovery process will benefit from a theoretical approach that captures both the dynamic and the idiographic nature of substance abuse recovery. In addition to setting out why we believe that research on recovery can benefit from such an approach, we provide a demonstration of idiographic within-individual analyses of between- and within-day associations among negative affect, substance use craving, and positive social experiences. Design and Subjects: The data used were drawn from 39 abstinent young adults in 12-step recovery from substance abuse (mean age = 22.9, females = 12). Participants provided an average of 26.7 days of daily diary data by end-of-day collections. Unified first-order structural equation models were fit individually to predict daily levels of craving and negative affect from the previous day’s same two variables as well as from both the previous day’s and the same day’s positive social experiences. Results: Model estimates demonstrated substantial interindividual heterogeneity in their day-to-day associations in both direction and magnitude, highlighting the importance of applying idiographic approach to understanding recovery. Cluster analyses were subsequently applied to individual model estimates to identify homogeneous subgroups that demonstrated similar day-to-day association patterns, revealing two distinct subgroups that appeared to manage daily abstinence through different mechanisms. Conclusions: The idiographic approach presented provides the potential value of framing recovery as an idiosyncratic dynamic process and provides targets for tailored and adaptive treatment and recovery supporting intervention in future design and evaluation.

 

 

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