Society for Ambulatory Assessment

Fourth quarter 2016 (October to December)

Band, Rebecca; Barrowclough, Christine; Caldwell, Kim; Emsley, Richard; Wearden, Alison (2016): Activity patterns in response to symptoms in patients being treated for chronic fatigue syndrome: An experience sampling methodology study.

In: Health psychology : official journal of the Division of Health Psychology, American Psychological Association. DOI: 10.1037/hea0000422.

Objective: Cognitive-behavioral models of chronic fatigue syndrome (CFS) propose that patients respond to symptoms with 2 predominant activity patterns-activity limitation and all-or-nothing behaviors-both of which may contribute to illness persistence. The current study investigated whether activity patterns occurred at the same time as, or followed on from, patient symptom experience and affect. Method: Twenty-three adults with CFS were recruited from U.K. CFS services. Experience sampling methodology (ESM) was used to assess fluctuations in patient symptom experience, affect, and activity management patterns over 10 assessments per day for a total of 6 days. Assessments were conducted within patients’ daily life and were delivered through an app on touchscreen Android mobile phones. Multilevel model analyses were conducted to examine the role of self-reported patient fatigue, pain, and affect as predictors of change in activity patterns at the same and subsequent assessment. Results: Current experience of fatigue-related symptoms and pain predicted higher patient activity limitation at the current and subsequent assessments whereas subjective wellness predicted higher all-or-nothing behavior at both times. Current pain predicted less all-or-nothing behavior at the subsequent assessment. In contrast to hypotheses, current positive affect was predictive of current activity limitation whereas current negative affect was predictive of current all-or-nothing behavior. Both activity patterns varied at the momentary level. Conclusions: Patient symptom experiences appear to be driving patient activity management patterns in line with the cognitive-behavioral model of CFS. ESM offers a useful method for examining multiple interacting variables within the context of patients’ daily life. (PsycINFO Database Record


Benarous, Xavier; Edel, Yves; Consoli, Angele; Brunelle, Julie; Etter, Jean-Francois; Cohen, David; Khazaal, Yasser (2016): Ecological momentary assessment and smartphone application intervention in adolescents with substance use and comorbid severe psychiatric disorders: study protocol.

In: Frontiers in psychiatry 7, S. 157. DOI: 10.3389/fpsyt.2016.00157.

CONTEXT: Substance use disorders (SUDs) are highly prevalent among inpatient adolescents with psychiatric disorders. In this population, substance use and other psychiatric outcomes can reinforce one another. Despite the need for integrated interventions in youths with dual diagnoses, few specific instruments are available. App-based technologies have shown promising results to help reduce substance use in adolescents, but their applicability in youths with associated severe psychiatric disorders is poorly documented. We aim to evaluate the feasibility of an ecological momentary assessment (EMA) intervention for all substance users, and of a smartphone application for cannabis users (Stop-Cannabis), for outpatient treatment after hospital discharge. METHODS AND ANALYSIS: All inpatient adolescents with psychiatric disorders hospitalized between 2016 and 2018 in a university hospital will be systematically screened for SUD and, if positive, will be assessed by an independent specialist addiction team. Participants with confirmed SUDs will be invited and helped to download an EMA app and, if required, the Stop-Cannabis app, the week preceding hospital discharge. Information about the acceptability and use of both apps and the validity of EMA data in comparison to clinical assessments will be assessed after 6 months and 1 year. DISCUSSION: This research has been designed to raise specific issues for consideration regarding the sequence between substance use, contextual factors, and other psychiatric symptoms among adolescents with comorbid severe psychiatric disorders. A better understanding of the mechanisms involved will inform the development of integrated treatment for dual disorders at that age. ETHICS AND DISSEMINATION: The study has already been approved and granted. Dissemination will include presentations at international congresses as well as publications in peer-reviewed journals. TRIAL REGISTRATION: European Clinical Trials Database: Number 2016-001999-30.


Berenson, Kathy R.; Dochat, Cara; Martin, Christiana G.; Yang, Xiao; Rafaeli, Eshkol; Downey, Geraldine (2016): Identification of mental states and interpersonal functioning in borderline personality disorder.

In: Personality disorders. DOI: 10.1037/per0000228.

Atypical identification of mental states in the self and others has been proposed to underlie interpersonal difficulties in borderline personality disorder (BPD), yet no previous empirical research has directly examined associations between these constructs. We examine 3 mental state identification measures and their associations with experience-sampling measures of interpersonal functioning in participants with BPD relative to a healthy comparison (HC) group. We also included a clinical comparison group diagnosed with avoidant personality disorder (APD) to test the specificity of this constellation of difficulties to BPD. When categorizing blended emotional expressions, the BPD group identified anger at a lower threshold than did the HC and APD groups, but no group differences emerged in the threshold for identifying happiness. These results are consistent with enhanced social threat identification and not general negativity biases in BPD. The Reading the Mind in the Eyes Test (RMET) showed no group differences in general mental state identification abilities. Alexithymia scores were higher in both BPD and APD relative to the HC group, and difficulty identifying one’s own emotions was higher in BPD compared to APD and HC. Within the BPD group, lower RMET scores were associated with lower anger identification thresholds and higher alexithymia scores. Moreover, lower anger identification thresholds, lower RMET scores, and higher alexithymia scores were all associated with greater levels of interpersonal difficulties in daily life. Research linking measures of mental state identification with experience-sampling measures of interpersonal functioning can help clarify the role of mental state identification in BPD symptoms. (PsycINFO Database Record


Blaauw, F. J.; Schenk, H. M.; Jeronimus, B. F.; van der Krieke, L.; Jonge, P. de; Aiello, M.; Emerencia, A. C. (2016): Let’s get Physiqual – An intuitive and generic method to combine sensor technology with ecological momentary assessments.

In: Journal of biomedical informatics 63, S. 141–149. DOI: 10.1016/j.jbi.2016.08.001.

The emergence of wearables and smartwatches is making sensors a ubiquitous technology to measure daily rhythms in physiological measures, such as movement and heart rate. An integration of sensor data from wearables and self-report questionnaire data about cognition, behaviors, and emotions can provide new insights into the interaction of mental and physiological processes in daily life. Hitherto no method existed that enables an easy-to-use integration of sensor and self-report data. To fill this gap, we present ‘Physiqual’, a platform for researchers that gathers and integrates data from commercially available sensors and service providers into one unified format for use in Ecological Momentary Assessments (EMA) or Experience Sampling Methods (ESM), and Quantified Self (QS). Physiqual currently supports sensor data provided by two well-known service providers and therewith a wide range of smartwatches and wearables. To demonstrate the features of Physiqual, we conducted a case study in which we assessed two subjects by means of data from an EMA study combined with sensor data as aggregated and exported by Physiqual. To the best of our knowledge, the Physiqual platform is the first platform that allows researchers to conveniently aggregate and integrate physiological sensor data with EMA studies.


Boh, Bastiaan; Jansen, Anita; Clijsters, Ineke; Nederkoorn, Chantal; Lemmens, Lotte H J M; Spanakis, Gerasimos; Roefs, Anne (2016): Indulgent thinking? Ecological momentary assessment of overweight and healthy-weight participants’ cognitions and emotions.

In: Behaviour research and therapy 87, S. 196–206. DOI: 10.1016/j.brat.2016.10.001.

Cognitions and emotions are considered important determinants of eating behaviour in cognitive behavioural models of obesity. Ecological data on these determinants is still limited. The present study investigated cognitions and emotions of overweight (n = 57) and healthy-weight (n = 43) participants via Ecological Momentary Assessment. It was found that eating-related cognitions mainly focused on desire and taste. Unexpectedly, dysfunctional cognitions (i.e., thoughts that may promote overeating) did not occur more often for overweight participants in almost all cases. So, the present EMA study provides no evidence for a role of dysfunctional cognitions in obesity-promoting eating behaviour when assessing eating-related cognitions immediately prior to eating events using a free-text format assessment. Right before eating events, participants mostly reported feeling calm/relaxed and cheerful/happy. Overweight participants scored higher on negative emotions, both at eating events and non-eating moments, than did healthy-weight participants. In addition, scores on standard questionnaires assessing emotional eating were positively associated with negative emotions reported at both eating and non-eating moments. As such, negative emotions, as assessed in the present study, do not seem to be specific triggers for food consumption.


Bonnot, O.; Bonneau, D.; Doudard, A.; Duverger, P. (2016): Rationale and protocol for using a smartphone application to study autism spectrum disorders: SMARTAUTISM.

In: BMJ open 6 (11), S. e012135. DOI: 10.1136/bmjopen-2016-012135.

INTRODUCTION: Longitudinal studies on the evolution of autism spectrum disorder (ASD) symptoms are limited and have primarily used repeated measurements performed several months apart. However, measurements of changes in everyday life should more closely reflect the ‘real life’ of the patient and his or her family. We propose to study the child’s ASD symptoms and their effect on the quality of life, psychological status and anxiety of the child’s parents over a 6-month period using SMARTAUTISM, a smartphone application. METHOD AND ANALYSIS: This is a prospective, longitudinal, exploratory, open study with a 6-month follow-up period. Data will be recorded longitudinally over multiple weeks under natural conditions. The factors affecting the quality of life and anxiety of parents of children with ASD and the children’s functional symptoms will be examined, and the feasibility of using a smartphone application designed for parents of ASD patients will be assessed. PRIMARY OBJECTIVE: Explore the evolution of a child’s behaviour over 6 months and the (psychological and social) effects of these changes on the family. SECONDARY OBJECTIVE: Assess the feasibility of our application by examining the filling rate and application usage by parents for 6 months. 100 families containing 1 child diagnosed with ASD will be included. At baseline, sociodemographic, psychiatric and medical data will be recorded. The correlations of the general epidemiological variables (primary outcome measure) will be evaluated via multivariate analysis. The application filling rate (relative to the ideal filling rate) will be used to assess the feasibility of the application (secondary outcome measure). ETHICS AND DISSEMINATION: The SMARTAUTISM study has the approval of the local ethics committee, and data security will be ensured via the use of encryption and a secure medical server. The use of this application will be proposed at autism resource centres across France.


Borders, Ashley; Lu, Shou-En (2016): The bidirectional associations between state anger and rumination and the role of trait mindfulness.

In: Aggressive behavior. DOI: 10.1002/ab.21693.

Rumination is associated with exacerbated angry mood. Angry moods may also trigger rumination. However, research has not empirically tested the bidirectional associations of state rumination and anger, as experience sampling methodology can do. We predicted that state anger and rumination would be bi-directionally associated, both concurrently and over time, even controlling for trait anger and rumination. In addition, because mindfulness is associated with rumination and anger at the bivariate level, we examined the effect of trait mindfulness on the bidirectional association between state rumination and anger. We examined two hypotheses: (i) state rumination mediates the effect of trait mindfulness on state anger; and (ii) trait mindfulness weakens, or moderates, the bidirectional associations between state rumination and anger. In an experience-sampling study, 200 college students reported their current ruminative thinking and angry mood several times a day for 7 days. Mixed model analyses indicated that state anger and rumination predicted each other concurrently. In cross-lagged analyses, previous anger did not uniquely predict current rumination; previous rumination predicted current anger, although the effect was small. In support of our hypothesis, state rumination mediated the association between trait mindfulness and state anger. Additionally, trait mindfulness moderated the concurrent and cross-lagged associations between state rumination and anger, although the results were complex. This study contributes new information about the complex interplay of rumination and anger. Findings also add support to the theory that mindfulness decreases emotional reactivity. Aggr. Behav. 9999:1-10, 2016. (c) 2016 Wiley Periodicals, Inc.


Bouwmans, M. E.; Bos, E. H.; Hoenders, H. J.; Oldehinkel, A. J.; Jonge, P. de (2017): Sleep quality predicts positive and negative affect but not vice versa. An electronic diary study in depressed and healthy individuals.

In: Journal of affective disorders 207, S. 260–267. DOI: 10.1016/j.jad.2016.09.046.

BACKGROUND: The exact nature of the complex relationship between sleep and affect has remained unclear. This study investigated the temporal order of change in sleep and affect in participants with and without depression. METHODS: 27 depressed patients and 27 pair-matched healthy controls assessed their sleep in the morning and their affect 3 times a day for 30 consecutive days in their natural environment. Daily sleep quality and average positive affect (PA) and negative affect (NA) were used to examine whether changes in sleep quality preceded or followed changes in PA and NA, and whether this was different for patients and healthy controls. Second, presumptive mediating factors were investigated. We hypothesized that fatigue mediated the effect of changes in sleep quality on subsequent PA/NA, and that rumination mediated the effect of changes in PA/NA on subsequent sleep quality. RESULTS: Multilevel models showed that changes in sleep quality predicted changes in PA (B=0.08, p<0.001) and NA (B=-0.06, p<0.001), but not the other way around (PA: B=0.03, p=0.70, NA: B=-0.05, p=0.60). Fatigue was found to be a significant mediator of the relationship between sleep quality and PA (Indirect Effect=0.03, p<0.001), and between sleep quality and NA (Indirect Effect=-0.02, p=0.01). Rumination was not investigated because of non-significant associations between PA/NA and sleep quality. The associations were not different for patients and controls. LIMITATIONS: The analyses were restricted to self-reported sleep quality, and conclusions about causality could not be drawn. CONCLUSIONS: Improvements in sleep quality predicted improvements in affect the following day, partly mediated by fatigue. Treatment of sleep symptoms would benefit affect in clinical care and beyond.


Bray, Paula; Bundy, Anita C.; Ryan, Monique M.; North, Kathryn N. (2016): Can in-the-moment diary methods measure health-related quality of life in duchenne muscular dystrophy?

In: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. DOI: 10.1007/s11136-016-1442-z.

AIM: To investigate whether in-the-moment diary reports of daily experience, taken collectively, are a valid representation of health-related quality of life (HRQL). METHODS: A total of 35 boys with Duchenne muscular dystrophy (DMD) were recruited through four neuromuscular care providers across Australia. Participants completed the PedsQL Generic Core scales and one week of experience-sampling diary reporting on a personal digital assistant. Rasch analysis was undertaken on the diary data to derive a single valid measure score. The resulting measure score for each participant was correlated with the summary score from the PedsQL Generic Core scales to examine whether daily experience was representative of HRQL. RESULTS: The daily diary method showed good metric properties, with adequate goodness of fit for data from items and participants suggesting unidimensionality of the construct: quality of everyday experience. The correlation of the daily diary measure score with overall PedsQL summary score showed moderate agreement (r = .60, p = 0.001). CONCLUSIONS: The benefits of measuring daily quality of life include detailed descriptions of day-to-day experiences of children without the need for retrospective recall. Diary methods on an electronic platform or software application for personal devices may be a useful tool to understand HRQL as the repeated measures data provide a detailed experience directly from the child and the platform makes data completion highly motivating.


Brinberg, M.; Ram, N.; Hulur, G.; Brick, T. R.; Gerstorf, D. (2016): Analyzing dyadic data using grid-sequence analysis: interdyad differences in intradyad dynamics.

In: The journals of gerontology. Series B, Psychological sciences and social sciences. DOI: 10.1093/geronb/gbw160.

OBJECTIVES: Spouses are proximal contexts for and influence each other’s behaviors, particularly in old age. In this article, we forward an integrated approach that merges state space grid methods adapted from the dynamic systems literature with sequence analysis methods adapted from molecular biology into a “grid-sequence” method for studying interdyad differences in intradyad dynamics. METHOD: Using dyadic data from 108 older couples (MAge = 75.18 years) with six within-day emotion and activity reports over 7 days, we illustrate how grid-sequence analysis can be used to identify a taxonomy of dyads with different emotion dynamics. RESULTS: Results provide a basis for measuring a set of dyad-level variables that capture dynamic equilibrium, daily routines, and interdyad differences. Specifically, we identified four groups of dyads who differed in how their moment-to-moment happiness was organized, with some evidence that these patterns were related to dyad-level differences in agreement on amount of time spent with partner and in subjective health. DISCUSSION: Methodologically, grid-sequence analysis extends the toolbox of techniques for analysis of dyadic experience sampling data. Substantively, we identify patterns of dyad-level microdynamics that may serve as new markers of risk/protective factors and potential points for intervention in older adults’ proximal context.


Businelle, M. S.; Ma, P.; Kendzor, D. E.; Frank, S. G.; Wetter, D. W.; Vidrine, D. J. (2016): Using intensive longitudinal data collected via mobile phone to detect imminent lapse in smokers undergoing a scheduled quit attempt.

In: Journal of medical Internet research 18 (10), S. e275. DOI: 10.2196/jmir.6307.

BACKGROUND: Mobile phonebased real-time ecological momentary assessments (EMAs) have been used to record health risk behaviors, and antecedents to those behaviors, as they occur in near real time. OBJECTIVE: The objective of this study was to determine if intensive longitudinal data, collected via mobile phone, could be used to identify imminent risk for smoking lapse among socioeconomically disadvantaged smokers seeking smoking cessation treatment. METHODS: Participants were recruited into a randomized controlled smoking cessation trial at an urban safety-net hospital tobacco cessation clinic. All participants completed in-person EMAs on mobile phones provided by the study. The presence of six commonly cited lapse risk variables (ie, urge to smoke, stress, recent alcohol consumption, interaction with someone smoking, cessation motivation, and cigarette availability) collected during 2152 prompted or self-initiated postcessation EMAs was examined to determine whether the number of lapse risk factors was greater when lapse was imminent (ie, within 4 hours) than when lapse was not imminent. Various strategies were used to weight variables in efforts to improve the predictive utility of the lapse risk estimator. RESULTS: Participants (N=92) were mostly female (52/92, 57%), minority (65/92, 71%), 51.9 (SD 7.4) years old, and smoked 18.0 (SD 8.5) cigarettes per day. EMA data indicated significantly higher urges (P=.01), stress (P=.002), alcohol consumption (P<.001), interaction with someone smoking (P<.001), and lower cessation motivation (P=.03) within 4 hours of the first lapse compared with EMAs collected when lapse was not imminent. Further, the total number of lapse risk factors present within 4 hours of lapse (mean 2.43, SD 1.37) was significantly higher than the number of lapse risk factors present during periods when lapse was not imminent (mean 1.35, SD 1.04), P<.001. Overall, 62% (32/52) of all participants who lapsed completed at least one EMA wherein they reported >/=3 lapse risk factors within 4 hours of their first lapse. Differentially weighting lapse risk variables resulted in an improved risk estimator (weighted area=0.76 vs unweighted area=0.72, P<.004). Specifically, 80% (42/52) of all participants who lapsed had at least one EMA with a lapse risk score above the cut-off within 4 hours of their first lapse. CONCLUSIONS: Real-time estimation of smoking lapse risk is feasible and may pave the way for development of mobile phonebased smoking cessation treatments that automatically tailor treatment content in real time based on presence of specific lapse triggers. Interventions that identify risk for lapse and automatically deliver tailored messages or other treatment components in real time could offer effective, low cost, and highly disseminable treatments to individuals who do not have access to other more standard cessation treatments.


Chi, N. W.; Yang, J.; Lin, C. Y. (2016): Service workers’ chain reactions to daily customer mistreatment: behavioral linkages, mechanisms, and boundary conditions.

In: Journal of occupational health psychology. DOI: 10.1037/ocp0000050.

Drawing on the stressor-emotion model, we examine how customer mistreatment can evoke service workers’ passive forms of deviant behaviors (i.e., work withdrawal behavior [WWB]) and negative impacts on their home life (i.e., work-family conflict [WFC]), and whether individuals’ core self-evaluations and customer service training can buffer the negative effects of customer mistreatment. Using the experience sampling method, we collect daily data from 77 customer service employees for 10 consecutive working days, yielding 546 valid daily responses. The results show that daily customer mistreatment increases service workers’ daily WWB and WFC through negative emotions. Furthermore, employees with high core self-evaluations and employees who received customer service training are less likely to experience negative emotions when faced with customer mistreatment, and thus are less likely to engage in WWB or provoke WFC. (PsycINFO Database Record


Chin, Alycia; Markey, Amanda; Bhargava, Saurabh; Kassam, Karim S.; Loewenstein, George (2016): Bored in the USA: Experience sampling and boredom in everyday life.

In: Emotion (Washington, D.C.). DOI: 10.1037/emo0000232.

We report new evidence on the emotional, demographic, and situational correlates of boredom from a rich experience sample capturing 1.1 million emotional and time-use reports from 3,867 U.S. adults. Subjects report boredom in 2.8% of the 30-min sampling periods, and 63% of participants report experiencing boredom at least once across the 10-day sampling period. We find that boredom is more likely to co-occur with negative, rather than positive, emotions, and is particularly predictive of loneliness, anger, sadness, and worry. Boredom is more prevalent among men, youths, the unmarried, and those of lower income. We find that differences in how such demographic groups spend their time account for up to one third of the observed differences in overall boredom. The importance of situations in predicting boredom is additionally underscored by the high prevalence of boredom in specific situations involving monotonous or difficult tasks (e.g., working, studying) or contexts where one’s autonomy might be constrained (e.g., time with coworkers, afternoons, at school). Overall, our findings are consistent with cognitive accounts that cast boredom as emerging from situations in which engagement is difficult, and are less consistent with accounts that exclusively associate boredom with low arousal or with situations lacking in meaning. (PsycINFO Database Record


Cho, H.; Gonzalez, R.; Lavaysse, L. M.; Pence, S.; Fulford, D.; Gard, D. E. (2016): Do people with schizophrenia experience more negative emotion and less positive emotion in their daily lives? A meta-analysis of experience sampling studies.

In: Schizophrenia research. DOI: 10.1016/j.schres.2016.11.016.

Research on emotion experience in response to valenced stimuli has consistently shown that people with schizophrenia have the capacity to experience emotion. Specifically, people with schizophrenia report similar experiences to both positive and negative emotion-eliciting stimuli as individuals without the disorder. However, it is less clear if people with schizophrenia experience similar levels of positive emotion and negative emotion outside of standardized laboratory contexts, as in their daily lives. One reliable method for assessing emotion experience in schizophrenia has been the Experience Sampling Method (ESM), or Ecological Momentary Assessment (EMA). Using the PRISMA guidelines for meta-analysis, we reviewed the literature for all studies that included people with and without schizophrenia, and that included a positive or negative emotion assessment during participants’ daily lives. The current study is a meta-analysis of 12 EMA studies of emotion experience, which included a total of 619 people with schizophrenia and 730 healthy controls. Results indicate that people with schizophrenia consistently report more negative and less positive emotion than healthy control participants. These findings differ from laboratory-based studies, which may be due to several factors, including environmental differences, effects of the disorder that appear more clearly in daily life, or additional concerns, such as depression, which has been shown to be related to negative emotion in schizophrenia. Importantly, these findings are in line with questionnaire-based measures of emotion experience, lending some support for their use in research and clinical settings.


Chue, A. E.; Gunthert, K. C.; Ahrens, A. H.; Skalina, L. M. (2016): How does social anger expression predict later depression symptoms? It depends on how often one is angry.

In: Emotion (Washington, D.C.). DOI: 10.1037/emo0000239.

Research has suggested that there are benefits to socially sharing anger as an emotion regulation strategy. We hypothesized that these benefits may depend on the frequency with which one is experiencing anger. We used an experience sampling methodology to explore the interaction between frequency of anger and reliance on social expression of anger as a predictor of changes in depression symptoms 4 months later. We found that a strong reliance on social expression prospectively predicted lower depression symptoms when participants endorsed anger infrequently but predicted an increase in subsequent depression symptoms when anger was endorsed frequently. This interaction was specific to anger and did not extend to sadness or anxiety. These results highlight the importance of considering the effectiveness of emotion regulation strategies in the context of specific emotions and the frequency of the experienced emotion in everyday life. (PsycINFO Database Record


D’Amico, E. J.; Martino, S. C.; Collins, R. L.; Shadel, W. G.; Tolpadi, A.; Kovalchik, S.; Becker, K. M. (2016): Factors associated with younger adolescents’ exposure to online alcohol advertising.

In: Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. DOI: 10.1037/adb0000224.

Little is known about the extent and nature of youth exposure to online alcohol advertising, or factors that may be associated with exposure. The current study recruited middle school students who completed a paper survey and then logged each alcohol advertisement that they encountered over a 2-week period using cell phones as part of an ecological momentary assessment design. We examined the percentage of youth who reported exposure to online alcohol advertising in the past 2 weeks, average weekly rate of exposure, types of online alcohol advertisements youth reported seeing, and factors that increased youths’ risk of exposure to online alcohol advertising. Analyses are based on 485 participants (47% female; 25% Hispanic, 25% White, 27% Black; 6% Asian, 16% other). Youth logged exposures to a total of 3,966 (16,018 weighted for underreporting) alcohol advertisements across the monitoring period; 154 (568 weighted) or 3.6% were online ads. Seventeen percent of youth reported seeing any online alcohol ad; the majority of online ads seen were video commercials (44.8%) and banner/side ads (26.6%). Factors associated with greater ad exposure were being older, rebellious, and Black race; greater parental monitoring and more hours spent on social media were associated with less exposure. Findings provide important information about adolescents’ exposure to online alcohol advertising and what might contribute to a greater likelihood of exposure. Given that online ad exposure is linked to drinking behavior, prevention programming for younger adolescents should continue to address this issue to help youth make healthy choices regarding alcohol use. (PsycINFO Database Record


Dao, Duy; Salehizadeh, S. M. A.; Noj, Yeon; Chong, Jo Woon; Cho, Chae; Mcmanus, Dave et al. (2016): A robust motion artifact detection algorithm for accurate detection of heart rates from photoplethysmographic signals using time-frequency spectral features.

In: IEEE journal of biomedical and health informatics. DOI: 10.1109/JBHI.2016.2612059.

Motion and noise artifacts (MNAs) impose limits on the usability of the photoplethysmogram (PPG), particularly in the context of ambulatory monitoring. MNAs can distort PPG, causing erroneous estimation of physiological parameters such as heart rate (HR) and arterial oxygen saturation (SpO2). In this study we present a novel approach, “TifMA,” based on using the Time-frequency spectrum of PPG to first detect the MNA-corrupted data and next discard the non-usable part of the corrupted data. The term “non-usable” refers to segments of PPG data from which the HR signal cannot be recovered accurately. Two sequential classification procedures were included in the TifMA algorithm. The first classifier distinguishes between MNA-corrupted and MNA-free PPG data. Once a segment of data is deemed MNA-corrupted, the next classifier determines whether the HR can be recovered from the corrupted segment or not. A support vector machine (SVM) classifier was used to build a decision boundary for the first classification task using data segments from a training data set. Features from time-frequency spectra of PPG were extracted to build the detection model. Five datasets were considered for evaluating TifMA performance: (1) and (2) were lab-controlled PPG recordings from forehead and finger pulse oximeter sensors with subjects making random movements, (3) and (4) were actual patient PPG recordings from UMass Memorial Medical Center with random free movements and (5) was a lab-controlled PPG recording dataset measured at the forehead while the subjects ran on a treadmill. The first dataset was used to analyze the noise sensitivity of the algorithm. Datasets 2-4 were used to evaluate the MNA detection phase of the algorithm. The results from the first phase of the algorithm (MNA detection) were compared to results from three existing MNA detection algorithms: the Hjorth, kurtosis-Shannon Entropy and time-domain variability-SVM approaches. This last is an approach recently developed in our lab. The proposed TifMA algorithm consistently provided higher detection rates than the other 3 methods, with accuracies greater than 95% for all data. Moreover, our algorithm was able to pinpoint the start and end time of the MNA with an error of less than 1 sec in duration, whereas the next-best algorithm had a detection error of more than 2.2 seconds. The final, most challenging, dataset was collected to verify the performance of the algorithm in discriminating between corrupted data that were usable for accurate HR estimations and data that were non-usable. It was found that on average 48% of the data segments were found to have MNA, and of these, 38% could be used to provide reliable HR estimation.


Dennis, Paul A.; Kimbrel, Nathan A.; Sherwood, Andrew; Calhoun, Patrick S.; Watkins, Lana L.; Dennis, Michelle F.; Beckham, Jean C. (2016): Trauma and autonomic dysregulation: episodic – versus systemic – negative affect underlying cardiovascular risk in posttraumatic stress disorder.

In: Psychosomatic medicine. DOI: 10.1097/PSY.0000000000000438.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart-rate variability (HRV) in cross-sectional research. Recent evidence suggests that this link may be driven by individual differences in autonomic arousal associated with momentary negative affect (NA). Using ecological momentary assessment (EMA) of NA and minute-to-minute HR/HRV monitoring, we examined whether NA-related HR/HRV mediated the association of PTSD symptom severity with 24-hour HRV and endothelial functioning. METHODS: One hundred ninety-seven young adults (18-39 years old), 93 with PTSD, underwent one day of Holter monitoring while concurrently reporting NA levels via EMA. Two non-invasive measures of endothelial functioning-flow-mediated dilation (FMD) and hyperemic flow-were also collected. Multilevel modeling was used to assess the associations of momentary NA with HR and low- (LF) and high-frequency (HF) HRV during the 5-minute intervals following each EMA reading. Latent variable modeling was then used to determine whether individual differences in these associations mediated the association of PTSD symptom severity with 24-hour HRV, FMD, and hyperemic flow RESULTS: PTSD symptom severity was positively associated with NA-related autonomic arousal (beta = .21, p < .001), which significantly mediated the association of PTSD symptom severity with 24-hour HRV and hyperemic flow, accounting for 62% and 34% of their associations, respectively, while overshadowing the influence of smoking, lifetime alcohol dependence, sleep duration, mean NA, and episodes of acute NA. CONCLUSIONS: Results suggest that NA-related autonomic arousal is both a primary factor driving cardiovascular risk in PTSD and a potential point of intervention.


Dunton, Genevieve Fridlund (2017): Ecological momentary assessment in physical activity research.

In: Exercise and sport sciences reviews 45 (1), S. 48–54. DOI: 10.1249/JES.0000000000000092.

Theories explaining why individuals participate in physical activity often do not take into account within-person variation or dynamic patterns of change. Time-intensive methods such as Ecological Momentary Assessment are more conducive to capturing time- and spatially-varying explanatory factors and intraindividual fluctuations than traditional methods and thus may yield new insights into the prediction and modeling of physical activity behavior.


Ernst, L. L.; Harden, C. L.; Pennell, P. B.; Llewellyn, N.; Lau, C.; Barnard, S. et al. (2016): Medication adherence in women with epilepsy who are planning pregnancy.

In: Epilepsia 57 (12), S. 2039–2044. DOI: 10.1111/epi.13586.

OBJECTIVE: This study examines medication adherence among women with epilepsy via use of an electronic diary, as part of a prospective multicenter observational study designed to evaluate fertility in women with epilepsy (WWE) versus age-matched controls. METHODS: WWE and healthy age-matched controls, seeking pregnancy, were given an iPod Touch using a customized mobile application (the WEPOD App) for daily data tracking. Eighty-six WWE tracked seizures and antiepileptic drugs (AEDs). Tracking of nonepilepsy medications was optional. Diary data were counted from enrollment date until date of delivery, or up to 12 months if pregnancy was not achieved. Each day that subjects reported missing one or more AED was counted as nonadherence. Because adherence can only be determined in women who track consistently, we elected to include adherence data only for women who tracked >80% of days in the study. RESULTS: Approximately 75% of WWE tracked >80% of days and were included in medication adherence data analysis. In this group, medication adherence rate was 97.71%; 44% of women admitted to missing an AED on at least 1 day. Among the subgroup of WWE who recorded nonepilepsy medications, AED adherence rate was 98.56%, versus 93.91% for non-AEDs. SIGNIFICANCE: The 75% compliance rate with an electronic diary suggests that it may be useful to track medication adherence in future studies and in the clinical setting. In those who tracked, the observed medication adherence rate was considerably higher than the 75% adherence rate seen in previous epilepsy studies. This might be explained in part by selection bias, but may also result from properties of the diary itself (daily reminders, real time feedback given to the provider). Women reported a higher rate of adherence to AEDs than to other prescribed medications and supplements, suggesting that perceived importance of medications likely influences medication adherence, and warrants future study.


Fardouly, Jasmine; Pinkus, Rebecca T.; Vartanian, Lenny R. (2016): The impact of appearance comparisons made through social media, traditional media, and in person in women’s everyday lives.

In: Body image 20, S. 31–39. DOI: 10.1016/j.bodyim.2016.11.002.

Appearance comparisons are an important sociocultural factor influencing women’s body image. These comparisons can occur in different contexts (e.g., through magazines, social media, in person). However, little is known about the frequency and outcome of appearance comparisons made in different contexts in women’s everyday lives. Using Ecological Momentary Assessment methods, female undergraduate students (n=146) completed a brief online survey at random times every day for 5 days. They reported the frequency, direction (upward, lateral, downward), and context of appearance comparisons, and also reported their appearance satisfaction, mood, and diet and exercise thoughts and behaviors. Upward appearance comparisons were the most common across all contexts. Upward comparisons through social media were associated with more negative outcomes on all measures (except diet and exercise behavior) than comparisons made in person, and with more negative mood than comparisons in any other context. These findings highlight the importance of the appearance comparison context.


Fryd, A. S.; van Stan, J. H.; Hillman, R. E.; Mehta, D. D. (2016): Estimating subglottal pressure from neck-surface acceleration during normal voice production.

In: Journal of speech, language, and hearing research : JSLHR 59 (6), S. 1335–1345. DOI: 10.1044/2016_JSLHR-S-15-0430.

Purpose: The purpose of this study was to evaluate the potential for estimating subglottal air pressure using a neck-surface accelerometer and to compare the accuracy of predicting subglottal air pressure relative to predicting acoustic sound pressure level (SPL). Method: Indirect estimates of subglottal pressure (Psg’) were obtained from 10 vocally healthy speakers during loud-to-soft repetitions of 3 different /p/-vowel gestures (/pa/, /pi/, /pu/) at 3 pitch levels in the modal register. Intraoral air pressure, neck-surface acceleration, and radiated acoustic pressure were recorded, and the root-mean-square amplitude of the acceleration signal was correlated with Psg’ and SPL. Results: The coefficient of determination between accelerometer level and Psg’ was high when data were pooled from all vowel and pitch contexts for each participant (r2 = .68-.93). These relationships were stronger than corresponding relationships between accelerometer level and SPL (r2 = .46-.81). The average 95% prediction interval for estimating Psg’ using accelerometer level was +/-2.53 cm H2O, ranging from +/-1.70 to +/-3.74 cm H2O across participants. Conclusions: Accelerometer signal amplitude correlated more strongly with Psg’ than with SPL. Future work is warranted to investigate the robustness of the relationship in nonmodal voice qualities, individuals with voice disorders, and accelerometer-based ambulatory monitoring of subglottal pressure.


Fuller-Tyszkiewicz, Matthew; Hartley-Clark, Linda; Cummins, Robert A.; Tomyn, Adrian J.; Weinberg, Melissa K.; Richardson, Ben (2016): Using dynamic factor analysis to provide insights into data reliability in experience sampling studies.

In: Psychological assessment. DOI: 10.1037/pas0000411.

The past 2 decades have seen increasing use of experience sampling methods (ESMs) to gain insights into the daily experience of affective states (e.g., its variability, as well as antecedents and consequences of temporary shifts in affect). Much less attention has been given to methodological challenges, such as how to ensure reliability of test scores obtained using ESM. The present study demonstrates the use of dynamic factor analysis (DFA) to quantify reliability of test scores in ESM contexts, evaluates the potential impact of unreliable test scores, and seeks to identify characteristics of individuals that may account for their unreliable test scores. One hundred twenty-seven participants completed baseline measures (demographics and personality traits), followed by a 7-day ESM phase in which positive and negative state affect were measured up to 6 times per day. Analyses showed that although at the sample level, scores on these affect measures exhibited adequate levels of reliability, up to one third of participants failed to meet conventional standards of reliability. Where these low reliability estimates were not significantly associated with personality factors, they could-in some cases-be explained by model misspecification where a meaningful alternative structure was available. Despite these potential differences in factor structure across participants, subsequent modeling with and without these “unreliable” cases showed similar substantive results. Hence, the present findings suggest typical analyses based on ESM data may be robust to individual differences in data structure and/or quality. Ways to augment the DFA approach to better understand unreliable cases are discussed. (PsycINFO Database Record


Gerhart, James I.; Burns, John W.; Post, Kristina M.; Smith, David A.; Porter, Laura S.; Burgess, Helen J. et al. (2016): Relationships between sleep quality and pain-related factors for people with chronic low back pain: Tests of reciprocal and time of day effects.

In: Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. DOI: 10.1007/s12160-016-9860-2.

BACKGROUND: Poor sleep quality among people with chronic low back pain appears to be related to worse pain, affect, poor physical function, and pain catastrophizing. The causal direction between poor sleep and pain remains an open question, however, as does whether sleep quality exerts effects on low back pain differently across the course of the day. PURPOSE: This daily diary study examined lagged temporal associations between prior night sleep quality and subsequent day pain, affect, physical function and pain catastrophizing, the reverse lagged temporal associations between prior day pain-related factors and subsequent night sleep quality, and whether the time of day during which an assessment was made moderated these temporal associations. METHODS: Chronic low back pain patients (n = 105) completed structured electronic diary assessments five times per day for 14 days. Items included patient ratings of their pain, affect, physical function, and pain catastrophizing. RESULTS: Collapsed across all observations, poorer sleep quality was significantly related to higher pain ratings, higher negative affect, lower positive affect, poorer physical function, and higher pain catastrophizing. Lagged analyses averaged across the day revealed that poorer prior night sleep quality significantly predicted greater next day patient ratings of pain, and poorer physical function and higher pain catastrophizing. Prior poorer night sleep quality significantly predicted greater reports of pain, and poorer physical function, and higher pain catastrophizing, especially during the early part of the day. Sleep quality x time of day interactions showed that poor sleepers reported high pain, and negative mood and low function uniformly across the day, whereas good sleepers reported relatively good mornings, but showed pain, affect and function levels comparable to poor sleepers by the end of the day. Analyses of the reverse causal pathway were mostly nonsignificant. CONCLUSIONS: Sleep quality appears related not only to pain intensity but also to a wide range of patient mood and function factors. A good night’s sleep also appears to offer only temporary respite, suggesting that comprehensive interventions for chronic low back pain not only should include attention to sleep problems but also focus on problems with pain appraisals and coping.


Gevonden, M.; Myin-Germeys, I.; Wichers, M.; Booij, J.; van den Brink, W.; van Winkel, R.; Selten, J. P. (2016): Reactivity to social stress in ethnic minority men.

In: Psychiatry research 246, S. 629–636. DOI: 10.1016/j.psychres.2016.10.076.

Repeated exposures to social exclusion, through a process of sensitization, may result in larger responses to experiences of social stress. The current study tested the hypothesis that healthy Moroccan-Dutch men respond stronger to social stress than Dutch controls 1) in daily life, and 2) in an experimental set-up. A general population sample of 50 Moroccan-Dutch and 50 Dutch young adult males were tested with 1) the Experience Sampling Method, a structured diary technique, assessing reactivity to social stress in daily life, and 2) an experimental exposure to social peer evaluation. No group differences were found in affective or psychotic reactivity to daily social stress. When exposed to a negative social evaluation in the lab, a blunted affective response was found in the Moroccan-Dutch compared to the Dutch group, whereas the psychotic response did not differ significantly between groups. In conclusion, healthy Moroccan-Dutch men are not more sensitive to social stress than healthy Dutch men. Instead, the blunted affective response of Moroccan-Dutch men to peer evaluation may signify habituation rather than sensitization.


Haines, S. J.; Gleeson, J.; Kuppens, P.; Hollenstein, T.; Ciarrochi, J.; Labuschagne, I. et al. (2016): The wisdom to know the difference: strategy-situation fit in emotion regulation in daily life is associated with well-being.

In: Psychological science. DOI: 10.1177/0956797616669086.

The ability to regulate emotions is central to well-being, but healthy emotion regulation may not merely be about using the “right” strategies. According to the strategy-situation-fit hypothesis, emotion-regulation strategies are conducive to well-being only when used in appropriate contexts. This study is the first to test the strategy-situation-fit hypothesis using ecological momentary assessment of cognitive reappraisal-a putatively adaptive strategy. We expected people who used reappraisal more in uncontrollable situations and less in controllable situations to have greater well-being than people with the opposite pattern of reappraisal use. Healthy participants (n = 74) completed measures of well-being in the lab and used a smartphone app to report their use of reappraisal and perceived controllability of their environment 10 times a day for 1 week. Results supported the strategy-situation-fit hypothesis. Participants with relatively high well-being used reappraisal more in situations they perceived as lower in controllability and less in situations they perceived as higher in controllability. In contrast, we found little evidence for an association between greater well-being and greater mean use of reappraisal across situations.


Haynos, A. F.; Berg, K. C.; Cao, L.; Crosby, R. D.; Lavender, J. M.; Utzinger, L. M. et al. (2016): Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa.

In: Journal of abnormal psychology. DOI: 10.1037/abn0000202.

Despite robust support for the role of affect in the maintenance of binge eating and purging, the relationship between affect and restrictive eating remains poorly understood. To investigate the relationship between restrictive eating and affect, ecological momentary assessment data from 118 women with anorexia nervosa (AN) were used to examine trajectories of higher-order dimensions of negative affect (NA) and positive affect (PA), as well as lower-order dimensions of NA (Fear, Guilt) and PA (Joviality, Self-Assurance) relative to restrictive eating. Affect trajectories were modeled before and after restrictive eating episodes and AN subtype was examined as a moderator of these trajectories. Across the sample, Guilt significantly increased before and decreased after restrictive eating episodes. Global NA, Global PA, Fear, Joviality, and Self-Assurance did not vary relative to restrictive eating episodes across the sample. However, significant subtype by trajectory interactions were detected for PA indices. Among individuals with AN restricting subtype, Global PA, Joviality, and Self-Assurance decreased prior to and Self-Assurance increased following restrictive eating episodes. In contrast, Global PA and Self-Assurance increased prior to, but did not change following, restrictive eating episodes among individuals with AN binge eating/purging subtype. Results suggest that dietary restriction may function to mitigate guilt across AN subtypes and to enhance self-assurance among individuals with AN restricting subtype. (PsycINFO Database Record


Hershenberg, Rachel; Mavandadi, Shahrzad; Wright, Erin; Thase, Michael E. (2017): Anhedonia in the daily lives of depressed veterans: A pilot report on experiential avoidance as a moderator of emotional reactivity.

In: Journal of affective disorders 208, S. 414–417. DOI: 10.1016/j.jad.2016.10.011.

BACKGROUND: Decreased enjoyment from pleasant events is a key component of anhedonia, but evidence has been inconsistent demonstrating its association across levels of depressive symptom severity. We test the hypothesis that depressed participants who engage in greater (rather than lower) concurrent use of experiential avoidance strategies will demonstrate impaired positive (PA) and negative (NA) emotional reactivity when pleasant events take place. METHODS: 50 Veterans with a range of depression severity completed a 7-day phone-based ecological momentary assessment protocol that assessed the pleasantness of their recent activity, level of PA and NA, and concurrent use of experiential avoidance strategies. RESULTS: As events were rated as more pleasant, depressed Veterans using less experiential avoidance were distinguished from depressed Veterans using greater experiential avoidance, such that greater experiential avoidance interfered with PA and NA reactivity. LIMITATIONS: Small sample of primarily older men, all were Veterans, and assessments relied on self-reports of event pleasantness and depression; we did not include a control group. CONCLUSIONS: It is critical to understand how depressed individuals experience potentially rewarding aspects of their environments. Our study provides preliminary data that depressed individuals may benefit from positive events in daily life when experiential avoidance is low and may demonstrate impaired reactivity when avoidance is high. This study may help clinicians to identify the contexts that support hedonic responses to potentially rewarding aspects of their depressed patients’ environments.


Houben, M.; Claes, L.; Vansteelandt, K.; Berens, A.; Sleuwaegen, E.; Kuppens, P. (2017): The emotion regulation function of nonsuicidal self-injury: A momentary assessment study in inpatients with borderline personality disorder features.

In: Journal of abnormal psychology 126 (1), S. 89–95. DOI: 10.1037/abn0000229.

Studies using retrospective self-report or proxies of nonsuicidal self-injury (NSSI) in the lab have shown that NSSI is often preceded by intense negative emotions and followed by a decrease in negative emotions/tension, suggesting an emotion regulation function of NSSI. To investigate this emotion regulation function of NSSI in a more ecologically valid way, we used experience sampling methods to examine the temporal relationship between NSSI behavior and emotional experiences throughout the day in 30 inpatients currently staying in psychiatric hospitals. Because NSSI is especially prevalent and severe in patients with a borderline personality disorder (BPD), we focused on patients with high levels of BPD symptomatology. Results confirmed that high levels of negative emotion prospectively predicted a higher probability of engaging in NSSI in the next time interval. However, the occurrence of NSSI itself was related to concurrent increases in negative emotion and decreases in positive emotion, and even prospectively predicted an increase in negative emotion in the consecutive time interval. These preliminary results show that on a time scale of hours, instead of resulting in emotional relief, NSSI seems to be associated with a further increase in negative emotionality, shedding light on the cyclic nature of NSSI. (PsycINFO Database Record


Hui, C. Y.; Walton, R.; McKinstry, B.; Jackson, T.; Parker, R.; Pinnock, H. (2016): The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence.

In: Journal of the American Medical Informatics Association : JAMIA. DOI: 10.1093/jamia/ocw143.

OBJECTIVES: Telehealth is promoted as a strategy to support self-management of long-term conditions. The aim of this systematic review is to identify which information and communication technology features implemented in mobile apps to support asthma self-management are associated with adoption, adherence to usage, and clinical effectiveness. METHODS: We systematically searched 9 databases, scanned reference lists, and undertook manual searches (January 2000 to April 2016). We include randomized controlled trials (RCTs) and quasiexperimental studies with adults. All eligible papers were assessed for quality, and we extracted data on the features included, health-related outcomes (asthma control, exacerbation rate), process/intermediate outcomes (adherence to monitoring or treatment, self-efficacy), and level of adoption of and adherence to use of technology. Meta-analysis and narrative synthesis were used. RESULTS: We included 12 RCTs employing a range of technologies. A meta-analysis (n = 3) showed improved asthma control (mean difference -0.25 [95% CI, -0.37 to -0.12]). Included studies incorporated 10 features grouped into 7 categories (education, monitoring/electronic diary, action plans, medication reminders/prompts, facilitating professional support, raising patient awareness of asthma control, and decision support for professionals). The most successful interventions included multiple features, but effects on health-related outcomes were inconsistent. No studies explicitly reported adoption of and adherence to the technology system. CONCLUSION: Meta-analysis of data from 3 trials showed improved asthma control, though overall the clinical effectiveness of apps, typically incorporating multiple features, varied. Further studies are needed to identify the features that are associated with adoption of and adherence to use of the mobile app and those that improve health outcomes.


Hung, Shan; Li, Min-Shan; Chen, Yen-Lin; Chiang, Jung-Hsien; Chen, Ying-Yeh; Hung, Galen Chin-Lun (2016): Smartphone-based ecological momentary assessment for chinese patients with depression: An exploratory study in taiwan.

In: Asian journal of psychiatry 23, S. 131–136. DOI: 10.1016/j.ajp.2016.08.003.

Mobile mental health has a potential to improve the recognition and management of Chinese patients with depression. Currently, evidence regarding ecological momentary assessment (EMA) for depressive disorder mostly originates from Western studies. Herein, we examined the validity of smartphone-based EMA for depression in Chinese patients and explored the determinants of use. A smartphone application, iHOPE, was used to perform daily EMA of depression, anxiety, sleep and cognitive performance. Outpatients with depressive disorder were recruited to use iHOPE for 8 weeks. Clinical characteristics and smartphone use patterns were assessed at baseline. We enrolled 59 Chinese patients with depression. In 8 weeks, participants interacted with iHOPE for an average of 10.8 (SD=12.3) days; a trend of decreased frequency of use (p=0.03) was observed. Scores of HAM-D at baseline was associated with, of the first 2 weeks, scores of PHQ-9 (p=0.005), EMA of depression (p=0.003) and anxiety (p<0.001), and poorer sleep quality (p=0.023). Among the demographic, clinical and smartphone-use variables examined, only limited internet package for smartphone (<500M per month) predicted higher use of iHOPE (p=0.04). The present study provides initial evidence for the feasibility of smartphone-based EMA in Chinese patients with depression. Level of engagement needs to be improved before determining its clinical usefulness.


Husain, N.; Gire, N.; Kelly, J.; Duxbury, J.; McKeown, M.; Riley, M. et al. (2016): TechCare: mobile assessment and therapy for psychosis – an intervention for clients in the Early Intervention Service: A feasibility study protocol.

In: SAGE open medicine 4, S. 2050312116669613. DOI: 10.1177/2050312116669613.

OBJECTIVES: Technological advances in healthcare have shown promise when delivering interventions for mental health problems such as psychosis. The aim of this project is to develop a mobile phone intervention for people with psychosis and to conduct a feasibility study of the TechCare App. METHODS: The TechCare App will assess participant’s symptoms and respond with a personalised guided self-help-based psychological intervention with the aim of exploring feasibility and acceptability. The project will recruit 16 service users and 8-10 health professionals from the Lancashire Care NHS Foundation Trust Early Intervention Service. RESULTS: In strand 1 of the study, we will invite people to discuss their experience of psychosis and give their opinions on the existing evidence-based treatment (cognitive behavioural therapy) and how the mobile app can be developed. In strand 2, we will complete a test run with a small number of participants (n = 4) to refine the mobile intervention (TechCare). Finally, in strand 3 of the study, the TechCare App will be examined in a feasibility study with 12 participants. CONCLUSION: It has been suggested that there is a need for a rapid increase in the efforts to develop the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services globally.


Husen, K.; Rafaeli, E.; Rubel, J. A.; Bar-Kalifa, E.; Lutz, W. (2016): Daily affect dynamics predict early response in CBT: Feasibility and predictive validity of EMA for outpatient psychotherapy.

In: Journal of affective disorders 206, S. 305–314. DOI: 10.1016/j.jad.2016.08.025.

BACKGROUND: Previous studies have shown that individual differences in affect dynamics during depressed patients’ everyday lives allow the prediction of treatment outcome and of symptom reoccurrence in remitted patients. In this study, we analyze whether understanding patients’ affective states and their fluctuation patterns helps predict early treatment response (until session 5). METHODS: Ecological Momentary Assessment (EMA) strategies allow in-depth analyses of real-time affective states and of their dynamics. Repeated assessments were made four times a day during a two-week period to capture real-life affective states (positive affect, PA and negative affect, NA) and dynamics (fluctuations in NA and PA) before the start of outpatient treatment of 39 patients. Due to the nested structure of the data, hierarchical linear models were conducted. RESULTS: PA/NA ratios, as well as fluctuations in NA predicted early treatment response, even when adjusting for initial impairment. In contrast, mean levels of NA or PA, as well as fluctuations in PA did not predict treatment response. LIMITATIONS: The time between the EMA assessment and treatment onset varied between patients. However, this variation was not associated with early change. CONCLUSIONS: The results suggest that pre-treatment affect dynamics could provide valuable information for predicting treatment response independent of initial impairment levels. Better predictions of early treatment response help to improve treatment choices early in the treatment progress.


Keith, NiCole R.; Xu, Huiping; Groot, Mary de; Hemmerlein, Kimberly; Clark, Daniel O. (2016): Identifying contextual and emotional factors to explore weight disparities between ebese black and white women.

In: Clinical medicine insights. Women’s health 9 (Suppl 1), S. 85–93. DOI: 10.4137/CMWH.S34687.

BACKGROUND: Obese black women enrolled in weight loss interventions experience 50% less weight reduction than obese white women. This suggests that current weight loss strategies may increase health disparities. OBJECTIVE: We evaluated the feasibility of identifying daily contextual factors that may influence obesity. METHODS: In-home interviews with 16 obese (body mass index >/= 30) black and white urban poor women were performed. For 14 days, ecological momentary assessment (EMA) was used to capture emotion and social interactions every other day, and day reconstruction method surveys were used the following day to reconstruct the context of the prior day’s EMA. RESULTS: Factors included percentage of participants without weight scales (43.8%) or fitness equipment (68.8%) in the home and exposed to food at work (55.6%). The most frequently reported location, activity, and emotion were home (19.4 +/- 8.53), working (7.1 +/- 8.80), and happy (6.9 +/- 10.03), respectively. CONCLUSION: Identifying individual contexts may lead to valuable insights about obesogenic behaviors and new interventions to improve weight management.


Kenny, R.; Dooley, B.; Fitzgerald, A. (2016) Ecological momentary assessment of adolescent problems, coping efficacy, and mood states using a mobile phone app: An exploratory study.

In: JMIR mental health 3 (4), S. e51. DOI: 10.2196/mental.6361.

BACKGROUND: Mobile technologies have the potential to be used as innovative tools for conducting research on the mental health and well-being of young people. In particular, they have utility for carrying out ecological momentary assessment (EMA) research by capturing data from participants in real time as they go about their daily lives. OBJECTIVE: The aim of this study was to explore the utility of a mobile phone app as a means of collecting EMA data pertaining to mood, problems, and coping efficacy in a school-based sample of Irish young people. METHODS: The study included a total of 208 participants who were aged 15-18 years, 64% female (113/208), recruited from second-level schools in Ireland, and who downloaded the CopeSmart mobile phone app as part of a randomized controlled trial. On the app, participants initially responded to 5 single-item measures of key protective factors in youth mental health (formal help-seeking, informal help-seeking, sleep, exercise, and sense of belonging). They were then encouraged to use the app daily to input data relating to mood states (happiness, sadness, anger, stress, and worry), daily problems, and coping self-efficacy. The app automatically collected data pertaining to user engagement over the course of the 28-day intervention period. Students also completed pen and paper questionnaires containing standardized measures of emotional distress (Depression, Anxiety, and Stress Scale; DASS-21), well-being (World Health Organization Well-Being Index; WHO-5), and coping (Coping Strategies Inventory; CSI). RESULTS: On average the participants completed 18% (5/28) of daily ratings, and engagement levels did not differ across gender, age, school, socioeconomic status, ethnicity, or nationality. On a scale of 1 to 10, happiness was consistently the highest rated mood state (overall mean 6.56), and anger was consistently the lowest (overall mean 2.11). Pearson correlations revealed that average daily ratings of emotional states were associated with standardized measures of emotional distress (rhappiness=-.45, rsadness=.51, ranger=.32, rstress=.41, rworry=.48) and well-being (rhappiness=.39, rsadness =-.43, ranger=-.27, rstress=-.35, rworry=-.33). Inferential statistics indicated that single-item indicators of key protective factors were related to emotional distress, well-being, and average daily mood states, as measured by EMA ratings. Hierarchical regressions revealed that greater daily problems were associated with more negative daily mood ratings (all at the P<.001 level); however, when coping efficacy was taken into account, the relationship between problems and happiness, sadness, and anger became negligible. CONCLUSIONS: While engagement with the app was low, overall the EMA data collected in this exploratory study appeared valid and provided useful insights into the relationships between daily problems, coping efficacy, and mood states. Future research should explore ways to increase engagement with EMA mobile phone apps in adolescent populations to maximize the amount of data captured by these tools. TRIAL REGISTRATION: NCT02265978; (Archived by WebCite at


Khurana, Laura; Durand, Ellen M.; Gary, Sarah T.; Otero, Antonio V.; Gerzon, Millie C.; Beck, Jamie et al. (2016): Subjects with osteoarthritis can easily use a handheld touch screen electronic device to report medication use: qualitative results from a usability study.

In: Patient preference and adherence 10, S. 2171–2179. DOI: 10.2147/PPA.S94247.

OBJECTIVES: Electronic data capture is increasingly used to improve collection of patient-reported outcome measures in clinical trials and care. The validation of electronic patient-reported outcome devices requires information on patient preference and ease of use. This study conducted usability testing for a General Symptom Questionnaire and Medication Module on a handheld device for subjects with osteoarthritis (OA) to determine whether subjects can report on their symptoms and medication use using an electronic diary. METHODS: Nine subjects with OA participating in a large US mode equivalency study were surveyed independently in this study. Subjects completed a General Symptom Questionnaire and Medication Module using the LogPad(R) LW handheld device. Demographic and technology use information was collected, and the subjects were queried on device usability. RESULTS: Subjects reported that the handheld device was easy to use and that they were able to complete a General Symptom Questionnaire and Medication Module with little or no assistance. They did not report any issues with the screen or size of the device. Subjects were willing to travel with the device to complete electronic diaries at home or in public. Participants indicated that they would be able to use the handheld device to answer questions during a clinical trial. Subjects with OA experienced no physical discomfort during completion of either questionnaire. CONCLUSION: The General Symptom Questionnaire and Medication Module were usable and acceptable to subjects with OA on a handheld device. This was consistent regardless of previous experience and confidence with technology, despite the potential physical restrictions for an OA cohort.


Klaus, Kristina; Fischer, Susanne; Doerr, Johanna M.; Nater, Urs M.; Mewes, Ricarda (2016): Classifying fibromyalgia syndrome as a mental disorder? An ambulatory assessment study.

In: International journal of behavioral medicine. DOI: 10.1007/s12529-016-9603-6.

PURPOSE: Fibromyalgia syndrome (FMS) is associated with psychological distress. The recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) raises the question of whether FMS is classifiable as “somatic symptom disorder” (SSD) and consequently as a mental disorder. To address this, the present ambulatory assessment study focuses on the everyday life occurrence of SSD symptoms in FMS and their predictive value concerning severity indicators of widespread pain. METHOD: Ambulatory data were assessed six times daily on 14 consecutive days via iPod. Twenty-eight women suffering from FMS indicated symptoms associated with SSD (somatic illness beliefs, health anxiety, time/energy devoted to pain, or health concerns) and momentary pain levels. Questionnaires regarding potential covariates (such as somatization, depression, health status) were completed at two additional sessions in the research laboratory. RESULTS: On average, SSD symptoms occurred three to four times daily and were mild to moderate in severity. Furthermore, these symptoms were both concurrently and prospectively associated with momentary pain intensity and subjective impairment by pain. Twenty percent of the variance in pain intensity and 28 % of the variance in subjective impairment were explained by momentary variables (SSD symptoms and intake of pain medication). Eighty-two percent of persons with FMS fulfilled the psychological SSD criterion when considering everyday occurring symptoms with at least mild severity. CONCLUSION: FMS might be diagnosed as a mental disorder according to DSM-5 in many cases. SSD symptoms proved to have predictive value for FMS severity and may thus have clinical relevance for diagnostic, prognostic, and intervention purposes.


Klipker, K.; Wrzus, C.; Rauers, A.; Riediger, M. (2016): Hedonic orientation moderates the association between cognitive control and affect reactivity to daily hassles in adolescent boys.

In: Emotion (Washington, D.C.). DOI: 10.1037/emo0000241.

People often seek to regulate their affective reactions when confronted with hassles. Hassle reactivity is lower for people with higher cognitive control, presumably because of better affect regulation. Many adolescents, however, show higher hassle reactivity than children, despite better cognitive control. The present study aims to understand whether motivational differences when seeking to regulate affective experiences moderate the association between cognitive control and hassle reactivity in adolescence. We hypothesized that higher cognitive control is related to lower hassle reactivity only for adolescents with a strong hedonic orientation, that is, for adolescents who seek to maintain or enhance positive or to dampen negative affect. We investigated 149 boys’ (age range: 10-20 years) hedonic orientation and affect reactivity toward daily hassles during 2 weeks of experience sampling. Higher cognitive control, assessed with a working memory battery in the laboratory, was associated with stronger hassle reactivity in individuals with low hedonic orientation. The more hedonic-oriented individuals were, the lower was their hassle reactivity, but only in combination with high cognitive control. Our findings illustrate that higher cognitive control is not always related to lower hassle reactivity. Rather, when daily hassles compromise affect balance, hedonic orientation is equally important to understand affect reactivity in adolescent boys. (PsycINFO Database Record


Knapen, Stefan E.; Riemersma-van der Lek, Rixt F; Haarman, Bartholomeus C. M.; Schoevers, Robert A. (2016): Coping with a life event in bipolar disorder: ambulatory measurement, signalling and early treatment.

In: BMJ case reports 2016. DOI: 10.1136/bcr-2016-216123.

Disruption of the biological rhythm in patients with bipolar disorder is a known risk factor for a switch in mood. This case study describes how modern techniques using ambulatory assessment of sleep parameters can help in signalling a mood switch and start early treatment. We studied a 40-year-old woman with bipolar disorder experiencing a life event while wearing an actigraph to measure sleep-wake parameters. The night after the life event the woman had sleep later and shorter sleep duration. Adequate response of both the woman and the treating psychiatrist resulted in two normal nights with the use of 1 mg lorazepam, possibly preventing further mood disturbances. Ambulatory assessment of the biological rhythm can function as an add-on to regular signalling plans for prevention of episodes in patients with bipolar disorder. More research should be conducted to validate clinical applicability, proper protocols and to understand underlying mechanisms.


Kowalczyk, William J. (2016): The utility of geographically-explicit ecological momentary assessment: from description to intervention.

In: Social psychiatry and psychiatric epidemiology. DOI: 10.1007/s00127-016-1283-7.


Kratz, A. L.; Ehde, D. M.; Bombardier, C. H.; Kalpakjian, C. Z.; Hanks, R. A. (2016): Pain acceptance decouples the momentary associations between pain, pain interference, and physical activity in the daily lives of people with chronic pain and spinal cord injury.

In: The journal of pain : official journal of the American Pain Society. DOI: 10.1016/j.jpain.2016.11.006.

Pain acceptance is a robust predictor of adjustment to chronic pain; however, the dynamics of pain acceptance in daily life are largely unexamined. Furthermore, research on pain acceptance in those with pain and physical disability is needed. To examine pain acceptance in daily life, we collected 7 days of ecological momentary assessments of pain intensity and pain interference (5 times per day) with continuous accelerometry (physical activity) in 128 individuals with chronic pain and spinal cord injury. Multilevel modeling revealed that pain acceptance significantly moderated the momentary association between pain intensity and pain interference; those with higher pain acceptance experienced a blunted increase in interference when pain was high. Pain acceptance also moderated the association between pain intensity and physical activity; high pain acceptance was associated with an increase and low pain acceptance with a decrease in physical activity in the context of high pain. The activities engagement component of pain acceptance was a slightly more robust driver of these interaction effects; whereas activities engagement significantly moderated the association between momentary pain and pain interference as well as physical activity, pain willingness exerted a significant moderating effect on the momentary association between pain intensity and pain interference only. These findings suggest that both components contribute to the decoupling effects of pain acceptance. Task persistence did not show the same moderating effects, indicating that pain acceptance may be unique from other types of behavioral pain coping in its ability to decouple expected associations between pain intensity, pain interference, and physical activity. PERSPECTIVE: In the daily lives of individuals with chronic pain and spinal cord injury, pain acceptance buffered expected increases in pain interference and decreases in physical activity in the context of high pain. Findings can inform further development of models of chronic pain adjustment and of more efficient, effective treatment approaches.


Kukk, K.; Akkermann, K. (2017): Fluctuations in negative emotions predict binge eating both in women and men: An experience sampling study.

In: Eating disorders 25 (1), S. 65–79. DOI: 10.1080/10640266.2016.1241058.

This study investigated the associations between emotional fluctuations and emotion regulation difficulties in predicting binge eating and overeating episodes using the experience sampling method among 97 women and 61 men. Among women, fluctuations in negative emotion, emotion regulation difficulties, restrained eating, and the interaction of negative emotion fluctuations and emotion regulation difficulties predicted binge eating. Among men, trait impulsivity and fluctuations in negative emotion predicted binge eating. However, overeating did not associate with aforementioned aspects. Results suggest that fluctuations in negative emotions should be studied in the context of emotion regulation difficulties.


Lennarz, H. K.; Lichtwarck-Aschoff, A.; Finkenauer, C.; Granic, I. (2017): Jealousy in adolescents’ daily lives: How does it relate to interpersonal context and well-being?

In: Journal of adolescence 54, S. 18–31. DOI: 10.1016/j.adolescence.2016.09.008.

Past studies have shown that jealousy peaks in adolescence. However, little is known about how and when adolescents experience jealousy in their daily lives. The current study aimed to examine the relation between state jealousy, the more general propensity to feel jealous, the interpersonal contexts in which jealousy arises, and different forms of social comparison. The impact of jealousy on perceptions of well-being was also explored. We used an experience sampling method during two weekends with 68 adolescents (Mage = 13.94; 64.70% girls). Jealousy was common: On average, 90% of our sample experienced jealousy in 20% of the assessments. Adolescents reported more jealousy with peers than with family. Additionally, they experienced more jealousy when in online contexts than when in face-to-face peer contexts. The normative nature of jealousy, its developmental function and relation with well-being, and implications for understanding jealousy triggered in (highly social) online contexts are discussed.


Liao, Y.; Chou, C. P.; Huh, J.; Leventhal, A.; Dunton, G. (2016): Associations of affective responses during free-living physical activity and future physical activity levels: an ecological momentary assessment study.

In: International journal of behavioral medicine. DOI: 10.1007/s12529-016-9626-z.

PURPOSE: Affective response during physical activity may influence motivation to perform future physical activity behavior. However, affective response during physical activity is often assessed under controlled laboratory conditions. The current study used ecological momentary assessment (EMA) to capture affective responses during free-living physical activity performed by adults, and determined whether these affective responses predict future moderate-to-vigorous physical activity (MVPA) levels after 6 and 12 months. METHOD: At baseline, electronic EMA surveys were randomly prompted across 4 days asking about current activities and affective states (e.g., happy, stressed, energetic, tired). Affective response during physical activity was operationalized as the level of positive or negative affect reported when concurrent physical activity (e.g., exercise or sports) was also reported. Data were available for 82 adults. Future levels of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers, worn for seven consecutive days at 6 and 12 months after the baseline assessment. RESULTS: Feeling more energetic during physical activity was associated with performing more minutes of daily MVPA after both 6 and 12 months. Feeling less negative affect during physical activity was associated with engaging in more daily MVPA minutes after 12 months only. CONCLUSION: This study demonstrated how EMA can be used to capture affective responses during free-living physical activity. Results found that feelings more energetic and less negative during physical activity were associated with more future physical activity, suggesting that positive emotional benefits may reinforce behavior.


Liao, Y.; Chou, C. P.; Huh, J.; Leventhal, A.; Dunton, G. (2016): Examining acute bi-directional relationships between affect, physical feeling states, and physical activity in free-living situations using electronic ecological momentary assessment.

In: Journal of behavioral medicine. DOI: 10.1007/s10865-016-9808-9.

Current knowledge about the relationship of physical activity with acute affective and physical feeling states is informed largely by lab-based studies, which have limited generalizability to the natural ecology. This study used ecological momentary assessment to assess subjective affective and physical feeling states in free-living settings across 4 days from 110 non-physically active adults (Age M = 40.4, SD = 9.7). Light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) were measured objectively by an accelerometer. Multilevel modeling was used to test the bi-directional associations between affective and physical feeling states and LPA/MVPA minutes. Higher positive affect, lower negative affect and fatigue were associated with more MVPA over the subsequent 15 min, while higher negative affect and energy were associated with more LPA over the subsequent 15 and 30 min. Additionally, more LPA and MVPA were associated with feeling more energetic over the subsequent 15 and 30 min, and more LPA was additionally associated with feeling more negative and less tired over the subsequent 15 and 30 min. Positive and negative affective states might serve as antecedents to but not consequences of MVPA in adults’ daily lives. Changes in LPA may be predicted and followed by negative affective states. Physical feeling states appear to lead up to and follow changes in both LPA and MVPA.


Ma, P.; Kendzor, D. E.; Poonawalla, I. B.; Balis, D. S.; Businelle, M. S. (2016): Daily nicotine patch wear time predicts smoking abstinence in socioeconomically disadvantaged adults: An analysis of ecological momentary assessment data.

In: Drug and alcohol dependence 169, S. 64–67. DOI: 10.1016/j.drugalcdep.2016.10.013.

INTRODUCTION: Individuals who use the nicotine patch are more likely to quit smoking than those who receive placebo or no medication. However, studies have not yet examined the association between actual daily nicotine patch wear time during the early phase of a smoking cessation attempt and later smoking abstinence. The purpose of this study was to address this gap in the literature. METHODS: Participants who enrolled in a safety-net hospital smoking cessation program were followed for 13 weeks (i.e., 1 week pre-quit through 12 weeks post-quit). Participants completed in-person assessments and daily ecological momentary assessments on study provided smartphones. Multivariate logistic regressions were used to determine if daily patch wear time during the first week post-quit predicted 7-day biochemically verified point prevalence smoking abstinence 4 and 12 weeks following the scheduled quit date. Demographic characteristics and smoking behaviors were adjusted as covariates. RESULTS: Participants (N=74) were primarily non-White (78.7%) and most (86%) had an annual household income of <$20,000. Greater average hours of daily nicotine patch wear time during the first week post-quit was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=2.22, 95% CI:1.17-4.23; aOR=2.24, 95% CI:1.00-5.03). Furthermore, more days of wearing the patch for >/=19h was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=1.81, 95% CI:1.01-3.22; aOR=2.18, 95% CI:1.03-4.63). CONCLUSIONS: Greater adherence to the nicotine patch early in a quit attempt may increase the likelihood of smoking cessation among socioeconomically disadvantaged adults.


Marcusson-Clavertz, D.; Gusic, S.; Bengtsson, H.; Jacobsen, H.; Cardena, E. (2016): The relation of dissociation and mind wandering to unresolved/disorganized attachment: an experience sampling study.

In: Attachment & human development, S. 1–21. DOI: 10.1080/14616734.2016.1261914.

Individuals with unresolved/disorganized representations of childhood trauma (U/d attachment) report more psychological distress than others, but little is known about their everyday mentation. In the present study adults with childhood trauma (N = 45) completed the Berkeley-Leiden Adult Attachment Questionnaire-Unresolved (BLAAQ-U) and the Adult Attachment Interview (AAI), and reported everyday mentation during 5 days of experience sampling. The BLAAQ-U and the AAI showed a medium association with each other, but only the former significantly predicted negative affect, dissociation, and low control/awareness of mentation. Contrary to our predictions, U/d attachment did not significantly predict mind wandering, but the BLAAQ-U predicted endorsements of a negative mind wandering style. U/d attachment, as assessed by both instruments, was associated with the Poor attentional control style and beliefs in anomalous mental phenomena. Experience sampling is a valuable way to investigate everyday experiences in individuals with U/d attachment.


Mehta, Daryush D.; Cheyne, Harold A. 2nd; Wehner, Asa; Heaton, James T.; Hillman, Robert E. (2016): Accuracy of self-reported estimates of daily voice use in adults with normal and disordered voices.

In: American journal of speech-language pathology 25 (4), S. 634–641. DOI: 10.1044/2016_AJSLP-15-0105.

Purpose: Accurate estimation of daily patterns of vocal behavior is essential to understanding the role of voice use in voice disorders. Given that clinicians currently rely on patient self-report to assess daily vocal behaviors, this study sought to assess the accuracy with which adults with and without voice disorders can estimate their amount of daily voice use in terms of phonation time. Method: Eighteen subjects (6 patients, 6 matched members of a control group without voice disorders, 6 low voice users) wore the accelerometer-based Ambulatory Phonation Monitor (APM; model 3200, KayPENTAX, Montvale, NJ) for at least 5 workdays. Subjects were instructed to provide hourly self-reports of time spent talking using a visual analog scale. Spearman correlation coefficients and errors between self-reported and APM-based estimates of phonation time revealed subject- and group-specific characteristics. Results: A majority of subjects exhibited a significant bias toward overestimating their phonation times, with an average absolute error of 113%. Correlation coefficients between self-reported and APM-based estimates of phonation time ranged from statistically nonsignificant to .91, reflecting large intersubject variability. Conclusions: Subjects in all 3 groups were moderately accurate at estimating their hourly voice use, with a consistent bias toward overestimation. The results support the potential role that ambulatory monitoring could play in improving the clinical assessment of voice disorders.


Moran, Erin K.; Culbreth, Adam J.; Barch, Deanna M. (2017): Ecological momentary assessment of negative symptoms in schizophrenia: Relationships to effort-based decision making and reinforcement learning.

In: Journal of abnormal psychology 126 (1), S. 96–105. DOI: 10.1037/abn0000240.

Negative symptoms are a core clinical feature of schizophrenia, but conceptual and methodological problems with current instruments can make their assessment challenging. One hypothesis is that current symptom assessments may be influenced by impairments in memory and may not be fully reflective of actual functioning outside of the laboratory. The present study sought to investigate the validity of assessing negative symptoms using ecological momentary assessment (EMA). Participants with schizophrenia (N = 31) completed electronic questionnaires on smartphones 4 times a day for 1 week. Participants also completed effort-based decision making and reinforcement learning (RL) tasks to assess the relationship between EMA and laboratory measures, which tap into negative symptom relevant domains. Hierarchical linear modeling analyses revealed that clinician-rated and self-report measures of negative symptoms were significantly related to negative symptoms assessed via EMA. However, working memory moderated the relationship between EMA and retrospective measures of negative symptoms, such that there was a stronger relationship between EMA and retrospective negative symptom measures among individuals with better working memory. The authors also found that negative symptoms assessed via EMA were related to poor performance on the effort task, whereas clinician-rated symptoms and self-reports were not. Further, they found that negative symptoms were related to poorer performance on learning reward contingencies. The findings suggest that negative symptoms can be assessed through EMA and that working memory impairments frequently seen in schizophrenia may affect recall of symptoms. Moreover, these findings suggest the importance of examining the relationship between laboratory tasks and symptoms assessed during daily life. (PsycINFO Database Record


Moran, Landhing M.; Phillips, Karran A.; Kowalczyk, William J.; Ghitza, Udi E.; Agage, Daniel A.; Epstein, David H.; Preston, Kenzie L. (2016): Aripiprazole for cocaine abstinence: a randomized-controlled trial with ecological momentary assessment.

In: Behavioural pharmacology. DOI: 10.1097/FBP.0000000000000268.

Aripiprazole blocks psychostimulant seeking in a rat model of relapse. However, in humans, it may increase ongoing use. We tested aripiprazole specifically for relapse prevention. Methadone-maintained outpatients who were abstinent from cocaine in weeks 11-12 were randomized to double-blind aripiprazole (15 mg daily) or placebo in weeks 13-27 after 12 weeks of contingency management. Participants reported craving through ecological momentary. We stopped the trial because very few (18/41) participants fulfilled the abstinence criterion. The results suggested that aripiprazole delayed lapse [hazard ratio (HR)=0.45, 95% confidence interval (CI)=0.14-1.42, P=0.17] and relapse (HR=0.31, 95% CI=0.07-1.27, P=0.10), but the effects did not reach statistical significance. Unexpectedly, the proportion of participants reporting cocaine craving was higher in the aripiprazole group (Fisher’s exact P=0.026), although the frequency of craving was similar in the aripiprazole and placebo groups (1.89 vs. 1.16%, reffect=0.43, 95% CI=-0.08-0.76). The results suggest that in recently abstinent cocaine users, aripiprazole might delay relapse, but might also slightly increase craving. Difficulty in trial implementation underscores the fact that initial abstinence from cocaine is not a trivial hurdle.


Morgan, J. K.; Lee, G. E.; Wright, A. G.; Gilchrist, D. E.; Forbes, E. E.; McMakin, D. L. et al. (2016) Altered positive affect in clinically anxious youth: the role of social context and anxiety subtype.

In: Journal of abnormal child psychology. DOI: 10.1007/s10802-016-0256-3.

Anxious youth may experience altered positive affect (PA) relative to healthy youth, perhaps because of greater sensitivity to social experiences. Altered PA may be especially evident during the transition to adolescence, a period in which positive social events increase in salience and value. The current study evaluated whether anxious youth show differences in baseline PA, rate of return to baseline, and variability around baseline PA and tested whether these differences would depend on social context and anxiety subtype. Participants were 176 9- to 14-year-old youth, including 130 clinically anxious (with Social Anxiety Disorder, Generalized Anxiety Disorder, and/or Separation Anxiety Disorder) and 46 healthy youth. Youth reported their current PA, peak PA in the past hour, and social context in natural settings using ecological momentary assessment. Hierarchical linear models showed that both socially anxious and other anxious youth showed greater variability of PA relative to healthy youth. Youth with other anxiety disorders showed higher peak PA to a positive event relative to healthy youth. Feeling close to a friend was associated with higher peak PA, especially for socially anxious youth. Socially anxious youth showed significantly lower peak PA relative to both healthy and other anxious youth when interacting with a less close peer, but similar levels to these youth when interacting with a close friend. These findings suggest that clinically anxious youth may more sensitive to positive events and social interactions than healthy youth. Findings provide potential treatment targets for anxious youth, including applying regulatory strategies to positive events.


Nishizawa, H.; Shiba, N.; Nakamura, A. (2016) Usefulness of continuous actigraph monitoring in the assessment of the effect of corticosteroid treatment for Duchenne muscular dystrophy: a case report.

In: Journal of physical therapy science 28 (11), S. 3249–3251. DOI: 10.1589/jpts.28.3249.

[Purpose] This study evaluated the effect of corticosteroid treatment on the daily activity of a patient with Duchenne muscular dystrophy using an actigraph and examined whether this method produces the same results as the conventional motor-function evaluation methods. [Subject and Methods] A patient with 5 year-old Duchenne muscular dystrophy was recruited. An actigraph was attached to his waist to measure the energy expenditure and the number of steps taken by him during a period of two weeks, 14 days before and 14 days after corticosteroid administration. The outcomes of these measurements were compared with the results of conventional motor-function evaluation methods-the 10-m run test, 6-minute walk test, and North Star Ambulatory Assessment-on his next visit. [Results] The actigraph data for energy expenditure and the number of steps taken correlated well with the results of the above-mentioned conventional motor-function tests, and the value of each data point improved after corticosteroid administration. [Conclusion] An actigraph was effectively used to non-invasively measure consecutive daily activity for four weeks. It was easily done and the results were consistent with conventional motor-function evaluation methods.


Oulton, Kate; Wray, Jo; Carr, Lucinda; Hassiotis, Angela; Jewitt, Carey; Kerry, Sam et al. (2016): Pay more attention: a national mixed methods study to identify the barriers and facilitators to ensuring equal access to high-quality hospital care and services for children and young people with and without learning disabilities and their families.

In: BMJ open 6 (12), S. e012333. DOI: 10.1136/bmjopen-2016-012333.

INTRODUCTION: Despite evidence of health inequalities for adults with intellectual disability (ID) there has yet to be a comprehensive review of how well hospital services are meeting the needs of children and young people (CYP) with ID and their families. We do not know how relevant existing recommendations and guidelines are to CYP, whether these are being applied in the paediatric setting or what difference they are making. Evidence of parental dissatisfaction with the quality, safety and accessibility of hospital care for CYP with ID exists. However, the extent to which their experience differs from parents of CYP without ID is not known and the views and experiences of CYP with ID have not been investigated. We will compare how services are delivered to, and experienced by CYP aged 5-15 years with and without ID and their families to see what inequalities exist, for whom, why and under what circumstances. METHODS AND ANALYSIS: We will use a transformative, mixed methods case study design to collect data over four consecutive phases. We will involve CYP, parents and hospital staff using a range of methods; interviews, parental electronic diary, hospital and community staff questionnaire, patient and parent satisfaction questionnaire, content analysis of hospital documents and a retrospective mapping of patient hospital activity. Qualitative data will be managed and analysed using NVivo and quantitative data will be analysed using parametric and non-parametric descriptive statistics. ETHICS AND DISSEMINATION: The study will run from December 2015 to November 2018. We have Health Authority Approval (IRAS project ID: 193932) for phase 1 involving staff only and ethical and Health Authority Approval for phases 2-4 (IRAS project ID: 178525). We will disseminate widely to relevant stakeholders, using a range of accessible formats, including social media. We will publish in international peer-reviewed journals and present to professional, academic and lay audiences through national and international conferences.


Papp, Lauren M.; Kouros, Chrystyna D. (2016): Predicting young adults’ risk for engaging in prescription drug misuse in daily life from individual, partner, and relationship factors.

In: Substance abuse, S. 1–8. DOI: 10.1080/08897077.2016.1263590.

BACKGROUND: Mounting evidence based on retrospective and global assessments has established associations between prescription drug misuse and illicit drug use, alcohol abuse, mental health problems, risky sexual behaviors, and overdose deaths. However, there is a notable absence of identified risk and protective factors for an individual’s likelihood of engaging in misuse in real-world environments. METHODS: Using an experience sampling approach, the authors collected repeated moments of young adults’ (n = 95 participants drawn from 49 romantic couples) prescription drug misuse instances in daily life and tested multiple factors associated with the misuse. RESULTS: When examined in separate multilevel models, individual and relationship factors (but not partner factors) reliably predicted the likelihood of females’ and males’ prescription drug misuse in daily life. Specifically, females’ elevated dysphoria symptoms, alcohol problems, and relationship closeness were linked with an increased likelihood of misuse, whereas cohabiting decreased the likelihood of their misuse. Males’ higher levels of illicit drug use and relationship closeness were associated with increased likelihood of misuse, whereas their dysphoria symptoms were related to a lower likelihood of misuse. When examined in models that considered the predictors simultaneously, females’ misuse was associated with individual, partner, and relationship factors, whereas males’ misuse was not reliably associated with any of the factors. CONCLUSIONS: An experience sampling approach was effective for the near-real-time assessment of young adults’ prescription drug misuse in daily environments, and the likelihood of misuse was associated with risk and protective factors from multiple levels of influence. Education and treatment efforts designed to reduce prescription drug misuse may need to be tailored to accommodate males’ and females’ distinct predictors of misuse.


Pavlovic, M.; Zezelj, I. (2016): Not only when feeling down: The relationship between mood intensity and smoking behavior.

In: Substance use & misuse, S. 1–5. DOI: 10.1080/10826084.2016.1245334.

BACKGROUND: There is substantial empirical evidence that negative mood triggers smoking behavior, and less support for the similar effect of positive mood. However, the relationship between the intensity of mood and smoking remains relatively under-researched. OBJECTIVES: The present study explored the association between mood intensity and smoking behavior. METHODS: Seventy-three ad libitum smokers recorded their mood and concurrent number of smoked cigarettes three times daily for one week using electronic diary application. Real time assessment in natural environment enabled greater reliability, validity and generalizability of the collected data. RESULTS: We analyzed results using within-subjects approach and obtained significant growth trend in smoking behavior that concurred with the increase of mood intensity-smokers tended to increase their consumption of cigarettes when they were feeling either happy or sad in comparison to the situation when they were in neutral mood. IMPORTANCE: These findings raise implications regarding the role of mood intensity in initiating smoking behavior.


Pearson, Matthew R.; Bravo, Adrian J.; Kirouac, Megan; Witkiewitz, Katie (2016): The search for an elusive cutoff remains: Problems of binary classification of heavy drinking as an endpoint for alcohol clinical trials.

In: Drug and alcohol dependence 171, S. 91–96. DOI: 10.1016/j.drugalcdep.2016.11.015.

BACKGROUND: To examine whether a clinically meaningful alcohol consumption cutoff can be created for clinical samples, we used receiver operator characteristic (ROC) curves to derive gender-specific consumption cutoffs that maximized sensitivity and specificity in the prediction of a wide range of negative consequences from drinking. METHODS: We conducted secondary data analyses using data from two large clinical trials targeting alcohol use disorders: Project MATCH (n=1726) and COMBINE (n=1383). RESULTS: In both studies, we found that the ideal cutoff for men and women that maximized sensitivity/specificity varied substantially both across different alcohol consumption variables and alcohol consequence outcomes. Further, the levels of sensitivity/specificity were poor across all consequences. CONCLUSIONS: These results fail to provide support for a clinically meaningful alcohol consumption cutoff and suggest that binary classification of levels of alcohol consumption is a poor proxy for maximizing sensitivity/specificity in the prediction of negative consequences from drinking. Future research examining consumption-consequence associations should take advantage of continuous measures of alcohol consumption and alternative approaches for assessing the link between levels of consumption and consequences (e.g., ecological momentary assessment). Clinical researchers should consider focusing more directly on the consequences they aim to reduce instead of relying on consumption as a proxy for more clinically meaningful outcomes.


Reichenberger, Julia; Kuppens, Peter; Liedlgruber, Michael; Wilhelm, Frank H.; Tiefengrabner, Martin; Ginzinger, Simon; Blechert, Jens (2016): No haste, more taste: An EMA study of the effects of stress, negative and positive emotions on eating behavior.

In: Biological psychology. DOI: 10.1016/j.biopsycho.2016.09.002.

OBJECTIVES: Stress and emotions alter eating behavior in several ways: While experiencing negative or positive emotions typically leads to increased food intake, stress may result in either over- or undereating. Several participant characteristics, like gender, BMI and restrained, emotional, or external eating styles seem to influence these relationships. Thus far, most research relied on experimental laboratory studies, thereby reducing the complexity of real-life eating episodes. The aim of the present study was to delineate the effects of stress, negative and positive emotions on two key facets of eating behavior, namely taste- and hunger-based eating, in daily life using ecological momentary assessment (EMA). Furthermore, the already mentioned individual differences as well as time pressure during eating, an important but unstudied construct in EMA studies, were examined. METHODS: Fifty-nine participants completed 10days of signal-contingent sampling and data were analyzed using multilevel modeling. RESULTS: Results revealed that higher stress led to decreased taste-eating which is in line with physiological stress-models. Time pressure during eating resulted in less taste- and more hunger-eating. In line with previous research, stronger positive emotions went along with increased taste-eating. Emotional eating style moderated the relationship between negative emotions and taste-eating as well as hunger-eating. BMI moderated the relationship between negative as well as positive emotions and hunger-eating. CONCLUSIONS: These findings emphasize the importance of individual differences for understanding eating behavior in daily life. Experienced time pressure may be an important aspect for future EMA eating studies.


Reichert, M.; Tost, H.; Reinhard, I.; Schlotz, W.; Zipf, A.; Salize, H. J. et al. (2016): Exercise versus nonexercise activity: E-diaries unravel distinct effects on mood.

In: Medicine and science in sports and exercise. DOI: 10.1249/MSS.0000000000001149.

INTRODUCTION: The association between physical activity and mood is of major importance to increase physical activity as a prevention strategy for noncommunicable diseases and to improve mental health. Unfortunately, existing studies examining how physical activity and mood wax and wane within persons over time in everyday life do show ambiguous findings. Taking a closer look at these studies reveals that the aggregation levels differ tremendously. Whereas mood is conceptualized as a three-dimensional construct, physical activity is treated as a global construct not taking into account its distinct components like exercise (such as jogging) and non-exercise activity (NEA; such as climbing stairs). METHODS: To overcome these limitations, we conducted an ambulatory assessment study on the everyday life of 106 adults over 7 days continuously measuring NEA via accelerometers and repeatedly querying for mood in real time via GPS-triggered e-diaries. We used multilevel modeling to derive differential within-subject effects of exercise vs. NEA on mood and to conduct analyses on the temporal course of effects. RESULTS: Analyses revealed that exercise increased valence (beta=0.023; p<.05) and calmness (beta=0.022; p<.05). A tendency of decreasing energetic arousal (beta=-0.029) lacked significance. NEA, parameterized as 15-minute episodes of physical activity intensity in everyday life, increased energetic arousal (beta=0.135; p<.001) and decreased calmness (stand. beta=-0.080; p<.001). A tendency of increasing valence (beta=0.014) lacked significance. Using longer time intervals for NEA revealed similar findings, thus confirming our findings. CONCLUSION: Exercise and NEA differed regarding their within-subject effects on mood; whereas exercise increased valence and calmness, NEA increased energetic arousal and decreased calmness. Therefore, it appears necessary to clearly differentiate between exercise and NEA regarding their within-subject effects on mood-dimensions in both research and treatment.


Rickard, Nikki; Arjmand, Hussain-Abdulah; Bakker, David; Seabrook, Elizabeth (2016): Development of a nobile phone app to support self-mnitoring of eotional wll-bing: A mental health digital innovation.

In: JMIR mental health 3 (4), S. e49. DOI: 10.2196/mental.6202.

BACKGROUND: Emotional well-being is a primary component of mental health and well-being. Monitoring changes in emotional state daily over extended periods is, however, difficult using traditional methodologies. Providing mental health support is also challenging when approximately only 1 in 2 people with mental health issues seek professional help. Mobile phone technology offers a sustainable means of enhancing self-management of emotional well-being. OBJECTIVE: This paper aims to describe the development of a mobile phone tool designed to monitor emotional changes in a natural everyday context and in real time. METHODS: This evidence-informed mobile phone app monitors emotional mental health and well-being, and it provides links to mental health organization websites and resources. The app obtains data via self-report psychological questionnaires, experience sampling methodology (ESM), and automated behavioral data collection. RESULTS: Feedback from 11 individuals (age range 16-52 years; 4 males, 7 females), who tested the app over 30 days, confirmed via survey and focus group methods that the app was functional and usable. CONCLUSIONS: Recommendations for future researchers and developers of mental health apps to be used for research are also presented. The methodology described in this paper offers a powerful tool for a range of potential mental health research studies and provides a valuable standard against which development of future mental health apps should be considered.


Ritter, P. S.; Bermpohl, F.; Gruber, O.; Hautzinger, M.; Jansen, A.; Juckel, G. et al. (2016): Aims and structure of the german research consortium BipoLife for the study of bipolar disorder.

In: International journal of bipolar disorders 4 (1), S. 26. DOI: 10.1186/s40345-016-0066-0.

BACKGROUND: Bipolar disorder is a severe and heterogeneous mental disorder. Despite great advances in neuroscience over the past decades, the precise causative mechanisms at the transmitter, cellular or network level have so far not been unraveled. As a result, individual treatment decisions cannot be tailor-made and the uncertain prognosis is based on clinical characteristics alone. Although a subpopulation of patients have an excellent response to pharmacological monotherapy, other subpopulations have been less well served by the medical system and therefore require more focused attention. In particular individuals at high risk of bipolar disorder, young patients in the early stages of bipolar disorder, patients with an unstable highly relapsing course and patients with acute suicidal ideation have been identified as those in need. STRUCTURE: A research consortium of ten universities across Germany has therefore implemented a 4 year research agenda including three randomized controlled trials, one epidemiological trial and one cross-sectional trial to address these areas of unmet needs. The topics under investigation will be the improvement of early recognition, specific psychotherapy, and smartphones as an aid for early episode detection and biomarkers of lithium response. A subset of patients will be investigated utilizing neuroimaging (fMRI), neurophysiology (EEG), and biomaterials (genomics, transcriptomics). CONCLUSIONS: This article aims to outline the rationale, design, and methods of these individual studies.


Rowland, Z.; Wenzel, M.; Kubiak, T. (2016):´The effects of computer-based mindfulness training on Self-control and Mindfulness within Ambulatorily assessed network Systems across Health-related domains in a healthy student population (SMASH): study protocol for a randomized controlled trial.

In: Trials 17 (1), S. 570. DOI: 10.1186/s13063-016-1707-4.

BACKGROUND: Self-control is an important ability in everyday life, showing associations with health-related outcomes. The aim of the Self-control and Mindfulness within Ambulatorily assessed network Systems across Health-related domains (SMASH) study is twofold: first, the effectiveness of a computer-based mindfulness training will be evaluated in a randomized controlled trial. Second, the SMASH study implements a novel network approach in order to investigate complex temporal interdependencies of self-control networks across several domains. METHODS: The SMASH study is a two-armed, 6-week, non-blinded randomized controlled trial that combines seven weekly laboratory meetings and 40 days of electronic diary assessments with six prompts per day in a healthy undergraduate student population at the Johannes Gutenberg University Mainz, Germany. Participants will be randomly assigned to (1) receive a computer-based mindfulness intervention or (2) to a wait-list control condition. Primary outcomes are self-reported momentary mindfulness and self-control assessed via electronic diaries. Secondary outcomes are habitual mindfulness and habitual self-control. Further measures include self-reported behaviors in specific self-control domains: emotion regulation, alcohol consumption and eating behaviors. The effects of mindfulness training on primary and secondary outcomes are explored using three-level mixed models. Furthermore, networks will be computed with vector autoregressive mixed models to investigate the dynamics at participant and group level. This study was approved by the local ethics committee (reference code 2015_JGU_psychEK_011) and follows the standards laid down in the Declaration of Helsinki (2013). DISCUSSION: This randomized controlled trial combines an intensive Ambulatory Assessment of 40 consecutive days and seven laboratory meetings. By implementing a novel network approach, underlying processes of self-control within different health domains will be identified. These results will deepen the understanding of self-control performance and will guide to just-in-time individual interventions for several health-related behaviors. TRIAL REGISTRATION:, NCT02647801 . Registered on 15 December 2015 (registered retrospectively).


Russell, Michael A.; Wang, Lin; Odgers, Candice L. (2016): Witnessing substance use increases same-day antisocial behavior among at-risk adolescents: Gene-environment interaction in a 30-day ecological momentary assessment study.

In: Development and psychopathology 28 (4pt2), S. 1441–1456. DOI: 10.1017/S0954579415001182.

Many young adolescents are embedded in neighborhoods, schools, and homes where alcohol and drugs are frequently used. However, little is known about (a) how witnessing others’ substance use affects adolescents in their daily lives and (b) which adolescents will be most affected. The current study used ecological momentary assessment with 151 young adolescents (ages 11-15) to examine the daily association between witnessing substance use and antisocial behavior across 38 consecutive days. Results from multilevel logistic regression models indicated that adolescents were more likely to engage in antisocial behavior on days when they witnessed others using substances, an association that held when substance use was witnessed inside the home as well as outside the home (e.g., at school or in their neighborhoods). A significant Gene x Environment interaction suggested that the same-day association between witnessing substance use and antisocial behavior was significantly stronger among adolescents with, versus without, the dopamine receptor D4 seven repeat (DRD4-7R) allele. The implications of the findings for theory and research related to adolescent antisocial behavior are discussed.


Ryden, Anna; Leavy, Olivia C.; Halling, Katarina; Stone, Arthur A. (2016): Comparison of daily versus weekly recording of gastroesophageal reflux disease symptoms in patients with a partial response to proton pump inhibitor therapy.

In: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research 19 (6), S. 829–833. DOI: 10.1016/j.jval.2016.05.007.

BACKGROUND: The Reflux Symptom Questionnaire electronic Diary (RESQ-eD) and the Reflux Symptom Questionnaire 7-day recall (RESQ-7) are versions of a patient-reported outcome instrument that was developed and validated for measuring the frequency and intensity of symptoms in patients with gastroesophageal reflux disease (GERD) who have a partial response to proton pump inhibitor (PPI) therapy. OBJECTIVE: The aim of these analyses was to assess the ability of the RESQ-7 to reproduce findings based on RESQ-eD reports of the same symptoms. METHODS: These analyses are based on data from patients with GERD with a partial response to PPI ( identifier: NCT00703534). Participants completed the RESQ-eD twice daily for 7 days and the RESQ-7 on day 7. RESULTS: Data from 446 patients were available for these analyses. Symptom-level analyses showed that, for intensity, mean domain scores were higher for the RESQ-7 (range 1.49-2.72) than for the RESQ-eD (range 1.45-2.57); for frequency, scores were lower for the RESQ-7 (range 2.58-4.82) than for the RESQ-eD (range 4.22-6.24). Correspondence analyses of RESQ-7 and RESQ-eD mean domain scores indicated excellent agreement for intensity (correlation-concordance coefficient 0.77-0.83) and fair agreement for frequency (correlation-concordance coefficient 0.40-0.58). Mean RESQ-eD subscale intensity scores for GERD symptoms were higher for symptoms experienced during the daytime than for those occurring at nighttime. Symptom recall was not associated with peak or recency effects. CONCLUSIONS: Patients with GERD slightly overestimated the intensity of their reflux symptoms and markedly underestimated the frequency on weekly recall compared with twice-daily reporting.


Salvy, S-J; Feda, D. M.; Epstein, L. H.; Roemmich, J. N. (2016): Friends and social contexts as unshared environments: a discordant sibling analysis of obesity- and health-related behaviors in young adolescents.

In: International journal of obesity (2005). DOI: 10.1038/ijo.2016.213.

OBJECTIVE: This study examines the contribution of best friends’ weight and the peer social context (time spent alone versus with friends) as sources of unshared environment associated with variability in weight and health behaviors among weight-discordant siblings. METHODS: Pairs of same-sex biologic siblings (N=40 pairs; ages 13-17) were originally recruited as part of a study evaluating putative factors contributing to differences in adiposity among weight-discordant siblings. Siblings were asked to bring their best friends to the laboratory and siblings and friends’ height and weight were objectively measured. Siblings also completed multi-pass dietary recalls to assess energy intake and sugar sweetened beverage (SSB) consumption. Siblings’ physical activity was measured using accelerometry. Experience sampling methodology was used to assess sedentary behaviors/screen time and the number of occasions siblings spent alone and in the presence of friends. Multilevel models were used to estimate the relationships between predictors (best friends’ zBMI, time spent alone or with friends) and outcomes (siblings’ zBMI and obesity-related health behaviors). RESULTS: Best friends’ zBMI was the best predictor of participants’ zBMI, even when controlling for child’s birth weight. Best friends’ weight (zBMI) further predicted participants’ SSB intake and time engaged in sedentary behaviors. Being active with friends was positively associated with participants’ overall physical activity, whereas spending time alone was negatively associated with accelerometer counts regardless of siblings’ adiposity. CONCLUSIONS: A friends’ weight and the social context are unshared environmental factors associated with variability in adiposity among biologically-related weight-discordant siblings.International Journal of Obesity advance online publication, 20 December 2016; doi:10.1038/ijo.2016.213.


Santangelo, P. S.; Koenig, J.; Funke, V.; Parzer, P.; Resch, F.; Ebner-Priemer, U. W.; Kaess, M. (2016): Ecological momentary assessment of affective and interpersonal instability in adolescent non-suicidal self-injury.

In: Journal of abnormal child psychology. DOI: 10.1007/s10802-016-0249-2.

Affective and interpersonal instability, both core features of Borderline Personality Disorder (BPD), have been suggested to underlie non-suicidal self-injury (NSSI). Ecological momentary assessment (EMA) is the method of choice when investigating dynamic processes. Previously no study addressed affective and interpersonal instability in daily life of adolescents engaging in NSSI. Female adolescents with NSSI (n = 26) and age- and sex-matched healthy controls (n = 20) carried e-diaries on 2 consecutive weekends and were prompted in hourly intervals to rate their momentary affective state and feelings of attachment towards their mother and best friend. The majority of participants in the NSSI group also fulfilled diagnostic criteria for BPD (73%). Squared successive differences were calculated to quantify instability. Adolescents with NSSI reported less positive affect, t (44) = 6.94, p < 0.01, lower levels of attachment to the mother, t (44) = 5.53, p < 0.01, and best friend, t (44) = 4.36, p < 0.01. Both affective, t (44) = -5.55, p < 0.01, and interpersonal instability, mother: t (44) = -4.10, p < 0.01; best friend: t (44) = -4.57, p < 0.01, were significantly greater in adolescents engaging in NSSI. In the NSSI group, the number of BPD criteria met was positively correlated with affective instability, r = 0.40, p < 0.05, and instability of attachment to the best friend, r = 0.42, p < 0.05, but not instability of attachment towards the mother, r = 0.06, p = 0.79. In line with previous work in adults, NSSI is associated with affective and interpersonal instability assessed by EMA in adolescents. Preliminary findings highlight the association of affective and interpersonal instability with diagnostic criteria for BPD. Clinical implications and avenues for further research are discussed.


Schlee, W.; Pryss, R. C.; Probst, T.; Schobel, J.; Bachmeier, A.; Reichert, M.; Langguth, B. (2016): Measuring the moment-to-moment variability of tinnitus: The TrackYourTinnitus smart phone app.

In: Frontiers in aging neuroscience 8, S. 294. DOI: 10.3389/fnagi.2016.00294.

Tinnitus, the phantom perception of sound without a corresponding external sound, is a frequent disorder which causes significant morbidity. So far there is no treatment available that reliably reduces the tinnitus perception. The research is hampered by the large heterogeneity of tinnitus and the fact that the tinnitus perception fluctuates over time. It is therefore necessary to develop tools for measuring fluctuations of tinnitus perception over time and for analyzing data on single subject basis. However, this type of longitudinal measurement is difficult to perform using the traditional research methods such as paper-and-pencil questionnaires or clinical interviews. Ecological momentary assessment (EMA) represents a research concept that allows the assessment of subjective measurements under real-life conditions using portable electronic devices and thereby enables the researcher to collect longitudinal data under real-life conditions and high cost efficiency. Here we present a new method for recording the longitudinal development of tinnitus perception using a modern smartphone application available for iOS and Android devices with no costs for the users. The TrackYourTinnitus (TYT) app is available and maintained since April 2014. A number of 857 volunteers with an average age of 44.1 years participated in the data collection between April 2014 and February 2016. The mean tinnitus distress at the initial measurement was rated on average 13.9 points on the Mini-Tinnitus Questionnaire (Mini-TQ; max. 24 points). Importantly, we could demonstrate that the regular use of the TYT app has no significant negative influence on the perception of the tinnitus loudness nor on the tinnitus distress. The TYT app can therefore be proposed as a safe instrument for the longitudinal assessment of tinnitus perception in the everyday life of the patient.


Schondube, A.; Kanning, M.; Fuchs, R. (2016): The bidirectional effect between momentary affective states and exercise duration on a day level.

In: Frontiers in psychology 7, S. 1414. DOI: 10.3389/fpsyg.2016.01414.

Despite the well-documented positive effect of exercise on health outcomes, most people do not succeed in exercising regularly. In addition to several other influences, affective states seem to support exercise participation. Associations between exercise and affect have been shown in the laboratory. However, the dynamic relation between affect and exercise in daily life is not yet well-understood. The objective of this study was to investigate the bi-directional effect of momentary affective states on naturally occurring exercise and vice versa in healthy participants in real-life environments by applying an ecological momentary assessment design. We hypothesized that (1) exercise duration is positively associated with affective states on a day level, (2) affective states in the morning predict subsequent exercise duration, and (3) exercise duration predicts affective states in the evening on that respective day. Data from N = 60 students aged between 19 and 32 years were analyzed. Affect and exercise duration were assessed daily over a period of 20 days via an electronic diary. Multilevel analysis revealed that positive affective valence was positively associated with exercise duration (p = 0.003) on a day level. In addition, the more the participants exercised that respective day, the better and more content they felt in the evening (p = 0.009). Energetic arousal in the morning significantly predicted subsequent exercise duration (p = 0.045). The findings indicate that it would be worthwhile to focus more on within-subject analyses when analyzing the dynamic relation between affect and exercise. Furthermore, affective states should be taken into account in creating effective interventions to foster exercise behavior and enhance maintenance.


Schulte, Thomas E.; Roberts, Ellen K.; Birch, Kristina; Lisco, Steven J. (2016): Assessing electronic interruptions experienced by an anesthesiology clinical director.

In: Journal of clinical anesthesia 34, S. 658–660. DOI: 10.1016/j.jclinane.2016.07.004.

STUDY OBJECTIVE: The purpose of this study was to assess the workflow interruptions on an anesthesiology clinical director (CD). By assessing the interruptions on the CD, we hypothesize that these frequent interruptions would prohibit the CD from medical direction of residents or certified nurse anesthetists in operating rooms. DESIGN: Cellular phone data were obtained from Verizon Wireless statements over 10 months, August 2012 through May 2013. These data were from a single cellular phone carried by the anesthesia CD and subsequent overnight anesthesiologist 24 hours a day. The data obtained from the billing records included number of calls, date and time call occurred, number of minutes per call, and number of texts received. SETTING: These calls occurred in the operating room. PATIENTS: Not applicable. INTERVENTION: Not applicable. MEASUREMENTS: Phone calls, texts, and pager interruptions. MAIN RESULTS: A total of 19,924 calls and 19,803 texts were received by the CD. The phone calls minutes for this period were 31,236 minutes. A total of 15,831 (80%) of the calls occurred during this period (0600-1800). A total of 24 489 minutes (78%) of the total minutes occurred during this time. CONCLUSION: This study revealed that distracting events are frequent for an anesthesiology CD. The quantity of cellular phone interruptions, both calls and texts, by the anesthesiology CD was considered high. These calls occurred mainly during prime operating room time and utilization. As the CD is an integral part of the perioperative management team, they are expected to answer and return calls and texts promptly. Operating room efficiency and staff satisfaction decline if responses to these calls and texts are delayed. Although the nature of these distractions and interruptions can be viewed as having a positive or negative effect, many of these events are necessary to efficiently run the operating rooms.


Scott, Jan; Murray, Greg; Henry, Chantal; Morken, Gunnar; Scott, Elizabeth; Angst, Jules et al. (2016): Activation in bipolar disorders: A systematic review.

In: JAMA psychiatry. DOI: 10.1001/jamapsychiatry.2016.3459.

Importance: Increased activity and energy alongside mood change are identified in the DSM-5 as cardinal symptoms of mania and hypomania. A wide range of existing research suggests that this revision may be valid, but systematic integration of the evidence has not been reported. The term activation is understood as emerging from underlying physiological change and having objective (observable motor activity) and related subjective (energy) levels. Objectives: To systematically review studies of the clinical phenomenon of activation in bipolar disorder, to determine whether activation is statistically abnormal in bipolar disorder and demonstrably distinct from mood, and to identify any significant between- and within-individual differences in the dynamics of activation. Evidence Review: This systematic review of MEDLINE, PsycINFO, EMBASE, CINAHL, and PubMed databases from January 1, 1970, until September 30, 2016, identified 56 of a possible 3284 citations for (1) data-driven analyses of the dimensions and factor structure of mania and bipolar depression and (2) longitudinal studies reporting real-time objective monitoring or momentary assessment of daytime activity in individuals with bipolar disorder compared with other clinical or healthy control samples. Hand search of reference lists, specialty journals, websites, published conference proceedings, and dissertation abstracts and contact with other researchers ensured inclusion of gray literature and additional analyses as well as raw data if appropriate. Quality assessment was perfomed using the National Institutes of Health quality assessment tool. Findings: A total of 56 studies met eligibility criteria for inclusion in the review including 29 analyses of the factor structure of bipolar disorder, 3 of activity data from experimental sampling or ecological momentary assessment, and 20 actigraphy and 4 laboratory-based studies. Synthesizing findings across the studies revealed that the most robust finding was that mean levels of activity are lower during euthymia and depression in patients with bipolar disorder compared with healthy controls and other comparison groups (11 studies). The 7 ecological and laboratory studies show less organized or predictable patterns of behavior and a relative lack of habituation among patients with bipolar disorders compared with others. Factor analytic studies provide fairly consistent evidence that mood and activation represent distinct dimensions of bipolar disorder. Ten studies that examined interindividual and intraindividual patterns of activity suggest that mania may be better characterized by differences in robustness, variability, predictability, or complexity of activation rather than mean levels of activity. Conclusions and Relevance: Within the limitations of the data, this synthesis of available evidence broadly supports the elevation of activation as a criterion A symptom for bipolar disorder in DSM-5. Although the importance of activation in bipolar disorders has been acknowledged for more than a century, this review suggests that this critical construct is understudied and should be the topic of more systematic high-quality research.


Scott, Stacey B.; Ram, Nilam; Smyth, Joshua M.; Almeida, David M.; Sliwinski, Martin J. (2017): Age differences in negative emotional responses to daily stressors depend on time since event.

In: Developmental psychology 53 (1), S. 177–190. DOI: 10.1037/dev0000257.

Research on age differences in the experience of negative emotional states have produced inconsistent results, particularly when emotion is examined in the context of daily stress. Strength and vulnerability integration (SAVI; Charles, 2010) theory postulates that age differences in emotional states are contingent upon whether a stressor occurred, and whether sufficient time has passed since the stressor to allow older adults to benefit from theorized strengths. The present study uses an ecological momentary assessment design to examine how timing of daily stressors relates to age differences in negative emotional responses. Participants (N = 199, aged 25-65) completed mobile surveys up to 5 times daily for 14 days. They reported current mood and stressor exposure, as well as how long ago the stressor occurred. As expected, no age differences were observed in current negative affect (NA) for stressors which occurred in the previous 0-10 min. As predicted, older age was associated with less of a stressor-related increase in NA when a greater time had passed (i.e., 10 min to 2.5 hours) since stressor exposure. Consistent with previous results, there were no age differences in the effects of more distal stressors that occurred 2.5 to 5 hr ago, although NA remained significantly elevated. The present findings are consistent with SAVI’s predictions and advance understanding age differences in the time course relating everyday stressors to emotional responses. (PsycINFO Database Record)


Seidel, Maria; Petermann, Juliane; Diestel, Stefan; Ritschel, Franziska; Boehm, Ilka; King, Joseph A. et al. (2016): A naturalistic examination of negative affect and disorder-related rumination in anorexia nervosa.

In: European child & adolescent psychiatry 25 (11), S. 1207–1216. DOI: 10.1007/s00787-016-0844-3.

In anorexia nervosa (AN), volitional inhibition of rewarding behaviors, such as eating, involves a conflict between the desire to suppress appetite and the inherent motive to consume. This conflict is thought to have costs that carry over into daily life, e.g., triggering negative affect and/or recurring ruminations, which may ultimately impact long term outcome. Hence, increasing research effort is being dedicated to understand the link between emotional and ruminative processes in the etiology and maintenance of AN. We investigated whether affective states influence disorder-related rumination in AN applying “ecological momentary assessment”, a method which allows the experimenter to gain insight into psychological processes in the natural environment and assess data in real time. Participants (AN = 37, healthy controls = 33) were given a smartphone for 14 days. A ringtone signaled at six random time-points each day to fill in a questionnaire, which gauged disorder-typical thoughts about food and weight as well as affective state. Analyses, applying hierarchical linear models confirmed that AN patients spend more time thinking about food, body shape and weight than controls (p < 0.001). Additionally, the results support the hypothesis that momentary negative affect (but not baseline depression (p = 0.56) or anxiety symptoms (p = 0.60) are positively associated with a higher amount of disorder-related rumination in patients (p < 0.001). Our findings are in line with theories which claim that ruminative thinking induces a vulnerability to negative stimuli which, in turn, fosters heightened negative affect. Thus, therapeutic interventions could be improved by implementing modules that specifically target disorder-related rumination.


Sun, Alexander C.; Yao, Chengyang; Venkatesh, A. G.; Hall, Drew A. (2016): An efficient power harvesting mobile phone-based electrochemical biosensor for point-of-care health monitoring.

In: Sensors and actuators. B, Chemical 235, S. 126–135. DOI: 10.1016/j.snb.2016.05.010.

Cellular phone penetration has grown continually over the past two decades with the number of connected devices rapidly approaching the total world population. Leveraging the worldwide ubiquity and connectivity of these devices, we developed a mobile phone-based electrochemical biosensor platform for point-of-care (POC) diagnostics and wellness tracking. The platform consists of an inexpensive electronic module (< $20) containing a low-power potentiostat that interfaces with and efficiently harvests power from a wide variety of phones through the audio jack. Active impedance matching improves the harvesting efficiency to 79%. Excluding loses from supply rectification and regulation, the module consumes 6.9 mW peak power and can measure < 1 nA bidirectional current. The prototype was shown to operate within the available power budget set by mobile devices and produce data that matches well with that of an expensive laboratory grade instrument. We demonstrate that the platform can be used to track the concentration of secretory leukocyte protease inhibitor (SLPI), a biomarker for monitoring lung infections in cystic fibrosis patients, in its physiological range via an electrochemical sandwich assay on disposable screen-printed electrodes with a 1 nM limit of detection.


Tomko, R. L.; Saladin, M. E.; McClure, E. A.; Squeglia, L. M.; Carpenter, M. J.; Tiffany, S. T. et al. (2016): Alcohol consumption as a predictor of reactivity to smoking and stress cues presented in the natural environment of smokers.

In: Psychopharmacology. DOI: 10.1007/s00213-016-4472-x.

BACKGROUND AND RATIONALE: The high prevalence of co-occurring alcohol and tobacco use underscores the importance of understanding the influence of alcohol consumption on risk factors for smoking and relapse. Alcohol has been shown to impact reactivity to smoking and stress-related cues, both of which are common antecedents to smoking and smoking relapse. OBJECTIVE: The objective of the current study is to examine associations between alcohol use, cigarette craving, and stress reactivity following exposure to smoking and stress cues delivered in participants’ daily lives. METHODS: Using cue-reactivity ecological momentary assessment (CREMA), adult smokers (n = 138) reported cigarette craving, stress, and past hour alcohol use on a mobile device four times per day for 2 weeks, resulting in a range of 4493-5983 data points per analysis. Questions were followed by exposure to pictorial neutral, stressful, or smoking cues delivered via the mobile device. Craving and affect were re-assessed following cue exposure. RESULTS: Results showed that recent (past hour) alcohol use was significantly associated with increases in the following: (a) tonic (non-cue-elicited) cigarette craving, (b) stress cue-elicited cigarette craving, and (c) stress cue-elicited stress reactivity, in the context of high-baseline stress. There was no significant association between alcohol use and smoking cue-elicited craving. CONCLUSIONS: Alcohol use may increase risk for smoking and relapse to smoking by increasing cigarette craving and, in certain contexts, stress following stress cue exposure. Though alcohol is known for its anxiolytic properties, under some conditions, it may increase reactivity to stress cues.


Tornros, Tobias; Dorn, Helen; Reichert, Markus; Ebner-Priemer, Ulrich; Salize, Hans-Joachim; Tost, Heike et al. (2016): A comparison of temporal and location-based sampling strategies for global positioning system-triggered electronic diaries.

In: Geospatial health 11 (3), S. 473. DOI: 10.4081/gh.2016.473.

Self-reporting is a well-established approach within the medical and psychological sciences. In order to avoid recall bias, i.e. past events being remembered inaccurately, the reports can be filled out on a smartphone in real-time and in the natural environment. This is often referred to as ambulatory assessment and the reports are usually triggered at regular time intervals. With this sampling scheme, however, rare events (e.g. a visit to a park or recreation area) are likely to be missed. When addressing the correlation between mood and the environment, it may therefore be beneficial to include participant locations within the ambulatory assessment sampling scheme. Based on the geographical coordinates, the database query system then decides if a self-report should be triggered or not. We simulated four different ambulatory assessment sampling schemes based on movement data (coordinates by minute) from 143 voluntary participants tracked for seven consecutive days. Two location-based sampling schemes incorporating the environmental characteristics (land use and population density) at each participant’s location were introduced and compared to a time-based sampling scheme triggering a report on the hour as well as to a sampling scheme incorporating physical activity. We show that location-based sampling schemes trigger a report less often, but we obtain more unique trigger positions and a greater spatial spread in comparison to sampling strategies based on time and distance. Additionally, the location-based methods trigger significantly more often at rarely visited types of land use and less often outside the study region where no underlying environmental data are available.


van Ballegooijen, Wouter; Ruwaard, Jeroen; Karyotaki, Eirini; Ebert, David D.; Smit, Johannes H.; Riper, Heleen (2016): Reactivity to smartphone-based ecological momentary assessment of depressive symptoms (MoodMonitor): protocol of a randomised controlled trial.

In: BMC psychiatry 16 (1), S. 359. DOI: 10.1186/s12888-016-1065-5.

BACKGROUND: Ecological momentary assessment (EMA) of mental health symptoms may influence the symptoms that it measures, i.e. assessment reactivity. In the field of depression, EMA reactivity has received little attention. We aim to investigate whether EMA of depressive symptoms induces assessment reactivity. Reactivity will be operationalised as an effect of EMA on depressive symptoms measured by a retrospective questionnaire, and, secondly, as a change in response rate and variance of the EMA ratings. METHODS: This study is a 12-week randomised controlled trial comprising three groups: group 1 carries out EMA of mood and completes a retrospective questionnaire, group 2 carries out EMA of how energetic they feel and completes a retrospective questionnaire, group 3 is the control group, which completes only the retrospective questionnaire. The retrospective questionnaire (Centre for Epidemiologic Studies Depression scale; CES-D) assesses depressive symptoms and is administered at baseline, 6 weeks after baseline and 12 weeks after baseline. We aim to recruit 160 participants who experience mild to moderate depressive symptoms, defined as a Patient Health Questionnaire (PHQ-9) score of 5 to 15. This study is powered to detect a small between-groups effect, where no clinically relevant effect is defined as the effect size margin -0.25< d <0.25. DISCUSSION: To our knowledge, this is the first study to investigate whether self-rated EMA of depressive symptoms could induce assessment reactivity among mildly depressed individuals. TRIAL REGISTRATION: Netherlands Trial Register NTR5803. Registered 12 April 2016. .


Vandermause, R.; Neumiller, J. J.; Gates, B. J.; David, P.; Altman, M.; Healey, D. J. et al. (2016): Preserving self: medication-taking practices and preferences of older adults with multiple chronic medical conditions.

In: Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing 48 (6), S. 533–542. DOI: 10.1111/jnu.12250.

PURPOSE: To examine the experiences of older adults with multiple chronic medical conditions when a new medication was added to their existing multiple medication regimen. DESIGN: A multimethod qualitative design was used. Thirty adults 60 years of age with (a) at least three chronic medical diagnoses, (b) at least five medications at baseline, and (c) a new medication prescription were enrolled in a prospective study of 30 days duration, participating from their homes. METHODS: In-depth hermeneutic interviews (2 per 15 participants) and self-assessment diaries recorded on electronic tablets (daily per 30 participants) were completed. Transcribed interviews and self-recorded survey data were analyzed using hermeneutical analysis and ecological momentary assessment and content analysis, respectively. FINDINGS: Common reasons participants did not take medications as prescribed included tolerability, transportation, access to medications, and forgetting. The overarching pattern, “preserving self,” was supported by two patterns that subsumed several themes: (a) engaging the powerful hold of my illness, and (b) engaging providers in visioning health. CONCLUSIONS: A deeper understanding of the impact of receiving a new prescription and of managing medication reveals the challenges patients experience in preserving a sense of self. Healthcare providers of all disciplines should understand the meaning of medication prescribing and medication taking to ameliorate medication-taking difficulties. CLINICAL RELEVANCE: The provider-patient relationship is often cited as an area that needs to be addressed in healthcare practice. Our study emphasized the patients’ voices and their profound needs around medication management. The emphasis on preservation of self is an important finding that focalizes the concern.


Vilaysack, B.; Cordier, R.; Doma, K.; Chen, Y. W. (2016): Capturing everyday experiences of typically developing children aged five to seven years: A feasibility study of experience sampling methodology.

In: Australian occupational therapy journal 63 (6), S. 424–433. DOI: 10.1111/1440-1630.12336.

BACKGROUND: Understanding children’s perception of their experiences is imperative for developing client-centred interventions for paediatric populations. However, perceptions of young children in the myriad circumstances that they live in have not yet been properly investigated. Subsequently, this study tested the feasibility and appropriateness of experience sampling method (ESM), an ecological momentary assessment, on typically developing children aged between five and seven years. METHODS: Ten children (five boys and five girls) carried an Android(c) device with a pre-installed ESM survey exploring their everyday life and their perceived internal experiences. Children were asked to respond to the survey eight times daily, at random times generated by the device, for seven days. RESULTS: An acceptable signal response rate (47.6 +/- 18.9%) and short average time required for survey completion (83 +/- 49 seconds) supported the feasibility of the ESM for use in research with children aged between five and seven years. Children reported the questions were straightforward and survey completion interfered very little with everyday activities, supporting appropriateness of the method. Through graphic analysis we illustrated the usability of ESM for capturing the influence of everyday contexts on perceived internal experiences. CONCLUSIONS: The ESM holds promise for examining the impact of environmental context on everyday experiences of young typically developing children.


Violano, Pina; Roney, Linda; Bechtel, Kirsten (2015): The incidence of pedestrian distraction at urban intersections after implementation of a Streets Smarts campaign.

In: Injury epidemiology 2 (1), S. 18. DOI: 10.1186/s40621-015-0050-7.

BACKGROUND: Pedestrians distracted by digital devices or other activities are at a higher risk of injury as they cross streets. We sought to describe the incidence of pedestrians distracted by digital devices or other activities at two highly traveled urban intersections after the implementation of a pedestrian safety intervention at one of the intersections. METHODS: This was an observational field study of two urban intersections. Two investigators were stationed at each of the four corners of the intersection. Each pair of observers included one “person counter” and one “behavior counter”. The “person counter” tallied every individual who approached that corner from any of the three opposing corners. The “behavior counter” tallied every individual approaching from the three opposing corners who were exhibiting any of the following behaviors: 1) eating, 2) drinking, 3) wearing ear buds/headphones, 4) texting, 5) looking at mobile phone or reading something on mobile phone, or 6) talking on mobile phone. Every 15 min, each pair of observers rotated to the next corner of the same intersection, allowing each pair of observers to complete one 15-min observation at each of the four corners of the intersection. Intersection A had stencils at the curb cuts of each corner alerting pedestrians to put down a digital device while crossing the intersection while intersection B did not. RESULTS: 1362 pedestrians were observed; of those, 19 % were distracted by another activity at both intersections. Of the total, 9 % were using ear buds/headphones; 8 % were using a digital device (talking, texting, or looking down at it); and 2 % were eating or drinking. Inter-observer validity among observers (kappa) was 98 %. Of those that were distracted, 5 % were either using an assistive device (cane, walker, motorized scooter) or walking with a child (either on foot or in stroller). There were no differences in the proportion of pedestrians who were distracted at either intersection, except that more pedestrians were talking on a cell phone while crossing intersection B. CONCLUSIONS: It is unclear to what degree a pedestrian safety messaging campaign is effective in decreasing distraction by digital devices. Further evaluation of the effect of posted warnings about pedestrian distraction on the safety of crossing behaviors is needed.


Vogel, Nina; Ram, Nilam; Conroy, David E.; Pincus, Aaron L.; Gerstorf, Denis (2016): How the social ecology and social situation shape individuals’ affect valence and arousal.

In: Emotion (Washington, D.C.). DOI: 10.1037/emo0000244.

Many theories highlight the role social contexts play in shaping affective experience. However, little is known about how individuals’ social environments influence core affect on short time-scales (e.g., hours). Using experience sampling data from the iSAHIB, wherein 150 adults aged 18 to 89 years reported on 64,213 social interactions (average 6.92 per day, SD = 2.85) across 9 weeks of daily life, we examined how 4 features of individuals’ social ecology (between-person differences) and immediate social situations (within-person changes) were associated with core affect-valence and arousal-and how those associations differ with age. Results from multilevel models revealed that familiarity, importance, type of social partner, and gender composition of the social context were associated with affect valence and/or affect arousal. Higher familiarity, higher importance, and same-gender composition were associated with more positive affect valence and higher arousal. Interactions with family and friends were linked to more positive valence whereas nonfamily social partners were linked to higher arousal. Age moderated the associations between importance and affect arousal, and between type of social partner and both dimensions of core affect. Findings align with theoretical propositions, contributing to but also suggesting need for further precision regarding how development shapes the interplay between social context and moment-to-moment affective experience. (PsycINFO Database Record


Volmer, Judith; Fritsche, Andrea (2016): Daily negative work events and employees’ physiological and psychological reactions.

In: Frontiers in psychology 7, S. 1711. DOI: 10.3389/fpsyg.2016.01711.

Scholars have accumulated an abundant amount of knowledge on the association between work stressors and employees’ health and well-being. However, notions of the complex interplay of physiological and psychological components of stress reactions are still in their infancy. Building on the Allostatic Load (AL) model, the present study considers short-term within-person effects of negative work events (NWEs) on indicators of both physiological (i.e., salivary cortisol) and psychological distress responses (i.e., negative affect and emotional exhaustion). Multilevel findings from an experience sampling study with 83 healthcare professionals suggest that reported NWEs predict employees’ psychological but not endocrine stress responses. Results contribute to a more comprehensive understanding of employees’ daily response patterns to occupational stressors.


W, Adams Z.; McClure, E. A.; Gray, K. M.; Danielson, C. K.; Treiber, F. A.; Ruggiero, K. J. (2017): Mobile devices for the remote acquisition of physiological and behavioral biomarkers in psychiatric clinical research.

In: Journal of psychiatric research 85, S. 1–14. DOI: 10.1016/j.jpsychires.2016.10.019.

Psychiatric disorders are linked to a variety of biological, psychological, and contextual causes and consequences. Laboratory studies have elucidated the importance of several key physiological and behavioral biomarkers in the study of psychiatric disorders, but much less is known about the role of these biomarkers in naturalistic settings. These gaps are largely driven by methodological barriers to assessing biomarker data rapidly, reliably, and frequently outside the clinic or laboratory. Mobile health (mHealth) tools offer new opportunities to study relevant biomarkers in concert with other types of data (e.g., self-reports, global positioning system data). This review provides an overview on the state of this emerging field and describes examples from the literature where mHealth tools have been used to measure a wide array of biomarkers in the context of psychiatric functioning (e.g., psychological stress, anxiety, autism, substance use). We also outline advantages and special considerations for incorporating mHealth tools for remote biomarker measurement into studies of psychiatric illness and treatment and identify several specific opportunities for expanding this promising methodology. Integrating mHealth tools into this area may dramatically improve psychiatric science and facilitate highly personalized clinical care of psychiatric disorders.


Wallace, Meredith L.; McMakin, Dana L.; Tan, Patricia Z.; Rosen, Dana; Forbes, Erika E.; Ladouceur, Cecile D. et al. (2016): The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment.

In: Behaviour research and therapy 90, S. 87–95. DOI: 10.1016/j.brat.2016.12.012.

Do day-to-day emotions, social interactions, and sleep play a role in determining which anxious youth respond to supportive child-centered therapy (CCT) versus cognitive behavioral therapy (CBT)? We explored whether measures of day-to-day functioning (captured through ecological momentary assessment, sleep diary, and actigraphy), along with clinical and demographic measures, were predictors or moderators of treatment outcome in 114 anxious youth randomized to CCT or CBT. We statistically combined individual moderators into a single, optimal composite moderator to characterize subgroups for which CCT or CBT may be preferable. The strongest predictors of better outcome included: (a) experiencing higher positive affect when with one’s mother and (b) fewer self-reported problems with sleep duration. The composite moderator indicated that youth for whom CBT was indicated had: (a) more day-to-day sleep problems related to sleep quality, efficiency, and waking, (b) day-to-day negative events related to interpersonal concerns, (c) more DSM-IV anxiety diagnoses, and (d) college-educated parents. These findings illustrate the value of both day-to-day functioning characteristics and more traditional sociodemographic and clinical characteristics in identifying optimal anxiety treatment assignment. Future studies will need to enhance the practicality of real-time measures for use in clinical decision making and evaluate additional anxiety treatments.


Williams, D. M.; Dunsiger, S.; Emerson, J. A.; Gwaltney, C. J.; Monti, P. M.; Miranda, R., JR (2016):Self-paced exercise, affective response, and exercise adherence: a preliminary investigation using ecological momentary assessment.

In: Journal of sport & exercise psychology 38 (3), S. 282–291. DOI: 10.1123/jsep.2015-0232.

Affective response to exercise may mediate the effects of self-paced exercise on exercise adherence. Fiftynine low-active (exercise <60 min/week), overweight (body mass index: 25.0-39.9) adults (ages 18-65) were randomly assigned to self-paced (but not to exceed 76% maximum heart rate) or prescribed moderate intensity exercise (64-76% maximum heart rate) in the context of otherwise identical 6-month print-based exercise promotion programs. Frequency and duration of exercise sessions and affective responses (good/bad) to exercise were assessed via ecological momentary assessment throughout the 6-month program. A regression-based mediation model was used to estimate (a) effects of experimental condition on affective response to exercise (path a = 0.20, SE = 0.28, f2 = 0.02); (b) effects of affective response on duration/latency of the next exercise session (path b = 0.47, SE = 0.25, f2 = 0.04); and (c) indirect effects of experimental condition on exercise outcomes via affective response (path ab = 0.11, SE = 0.06, f2 = 0.10). Results provide modest preliminary support for a mediational pathway linking self-paced exercise, affective response, and exercise adherence.


Wilt, J.; Bleidorn, W.; Revelle, W. (2016): Finding alife worth living: meaning in life and graduation from college.

In: European journal of personality 30 (2), S. 158–167. DOI: 10.1002/per.2046.

Graduation from college is an important milestone for young adults, marked by mixed emotions and poignancy, and therefore is an especially salient context for studying meaning in life. The present research used experience-sampling methodology to examine the antecedents and consequences of students’ experience of meaning in life over the course of graduation. Participants were 74 graduating students who provided a total of 538 reports over the span of three days, including commencement day. Increased levels of state meaning in life during the days around commencement were linked to spending time with people in general and with family in particular, as well as thinking about one’s years in college. Thinking about one’s years in college mediated the effects of present company on state meaning in life. Graduates who experienced higher levels of state meaning in life during the days around their commencement ceremony had higher trait levels of meaning in life one week following commencement. We discuss how making meaning of a poignant experience has implications for healthy psychological development.


Wolff, M.; Kronke, K. M.; Venz, J.; Kraplin, A.; Buhringer, G.; Smolka, M. N.; Goschke, T. (2016): Action versus state orientation moderates the impact of executive functioning on real-life self-control.

In: Journal of experimental psychology. General 145 (12), S. 1635–1653. DOI: 10.1037/xge0000229.

Self-control is commonly assumed to depend on executive functions (EFs). However, it is unclear whether real-life self-control failures result from deficient EF competencies or rather reflect insufficient conflict-induced mobilization of executive control, and whether self-control depends more critically on function-specific EF competencies or general executive functioning (GEF), that is, common competencies that underlie all EFs. Here we investigated whether failure-related action versus state orientation, a personality trait related to the conflict-induced mobilization of cognitive control, moderates the effect of general and function-specific control competencies on self-control. To this end, 240 young adults completed questionnaire measures of action-state orientation and trait self-control, reported everyday self-control failures during 7 consecutive days via smartphone-based experience sampling, and completed 9 EF tasks from which latent variables reflecting GEF as well as inhibition-, updating-, and shifting-specific competencies were derived. Structural equation models confirmed that the effect of GEF on self-control was moderated by action-state orientation: action-oriented compared with more state-oriented participants showed a stronger inverse association between GEF and everyday self-control failures. Corresponding effects of function-specific competencies on self-control were not found. These results highlight that high executive functioning may enable self-controlled behavior only if control is sufficiently mobilized when needed and suggest that self-control may depend more critically on general than function-specific control competencies. More generally, the present study demonstrates the fruitfulness of combining latent-variable models of well-controlled EF tasks with experience sampling of daily self-control and measures of individual differences in control modes to bridge the gap between laboratory research and real-life behavior. (PsycINFO Database Record


Wu, H.; Mata, J.; Furman, D. J.; Whitmer, A. J.; Gotlib, I. H.; Thompson, R. J. (2016): Anticipatory and consummatory pleasure and displeasure in major depressive disorder: An experience sampling study.

In: Journal of abnormal psychology. DOI: 10.1037/abn0000244.

Pleasure and displeasure can be parsed into anticipatory and consummatory phases. However, research on pleasure and displeasure in major depressive disorder (MDD), a disorder characterized by anhedonia, has largely focused on deficits in the consummatory phase. Moreover, most studies in this area have been laboratory-based, raising the question of how component processes of pleasure and displeasure are experienced in the daily lives of depressed individuals. Using experience sampling, we compared anticipatory and consummatory pleasure and displeasure for daily activities reported by adults with MDD (n = 41) and healthy controls (n = 39). Participants carried electronic devices for one week and were randomly prompted eight times a day to answer questions about activities to which they most and least looked forward. Compared to healthy controls, MDD participants reported blunted levels of both anticipatory and consummatory pleasure and elevated levels of both anticipatory and consummatory displeasure for daily activities. Independent of MDD status, participants accurately predicted pleasure but overestimated displeasure. These results are the first to provide evidence that, across both anticipatory and consummatory phases, individuals with MDD experience blunted pleasure and elevated displeasure for daily activities. Our findings clarify the disturbances in pleasure and displeasure that characterize MDD and may inform treatment for this debilitating disorder. (PsycINFO Database Record

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