Society for Ambulatory Assessment

Third quarter 2012

aan het Rot, M., Hogenelst, K., & Schoevers, R. A. (2012). Mood disorders in everyday life: A systematic review of experience sampling and ecological momentary assessment studies. Clinical Psychology Review, 32, 510-523.

In the past two decades, the study of mood disorder patients using experience sampling methods (ESM) and ecological momentary assessment (EMA) has yielded important findings. In patients with major depressive disorder (MDD), the dynamics of their everyday mood have been associated with various aspects of their lives. To some degree similar studies have been conducted in patients with bipolar disorder (BD). In this paper we present the results of a systematic review of all ESM/EMA studies in MDD and BD to date. We focus not only on the correlates of patients’ everyday mood but also on the impact on treatment, residual symptoms in remitted patients, on findings in pediatric populations, on MDD/BD specificity, and on links with neuroscience. After reviewing these six topics, we highlight the benefits of ESM/EMA for researchers, clinicians, and patients, and offer suggestions for future studies.

Adamo, K. B., Langlois, K. A., Brett, K. E., & Colley, R. C. (2012). Young children and parental physical activity levels: findings from the canadian health measures survey. Am.J Prev.Med., 43, 168-175.

BACKGROUND: Physical inactivity is a global public health concern. The relationship between dependent children in the home and parental physical activity has not been quantified using objective measures, nor has the relative association of the physical activity levels of mothers and fathers been examined. PURPOSE: To investigate the association of children of different ages in the home on two measures of parental physical activity: daily moderate-to-vigorous physical activity (MVPA) and likelihood of meeting the guideline of 150 minutes of MVPA per week accumulated in 10-minute bouts. METHODS: Data were from the 2007-2009 Canadian Health Measures Survey (n=2315), and analyses were conducted between February and December 2011. MVPA was measured directly using accelerometry. Linear (minutes of MVPA) and logistic (meeting physical activity guidelines) regression models were performed to determine if the presence, number of children, or the age of the youngest child at home was associated with parental physical activity. All models were adjusted for parental age, marital status, household income, employment, and BMI. RESULTS: Mothers whose youngest child was aged <6 years and fathers whose youngest was aged 6-11 years engaged in fewer minutes of daily MVPA than those without dependent children. Linear regression results identified that in comparison to those without children, women whose youngest child in the home was aged <6 years participated in 7.7 minutes less activity per day (p=0.007) whereas men engaged in 5.7 fewer minutes per day, or 54 and 40 minutes per week less, respectively. Similarly, logistic regression analyses indicated that both women and men were less likely to meet guidelines if their youngest child in the home was aged <6 years (OR=0.31, 95% CI=0.11, 0.87; OR=0.34, 95% CI=0.13, 0.93). CONCLUSIONS: The physical activity level of parents with young children present in the home was lower than that of those without children. Given the many physiologic, psychological, and social benefits of healthy active living, research efforts should continue to focus on strategies to encourage parents with young children to establish or re-engage in a physically active lifestyle, not only for their own health but to model healthy behavior for the next generation

Allena, M., Cuzzoni, M. G., Tassorelli, C., Nappi, G., & Antonaci, F. (2012). An electronic diary on a palm device for headache monitoring: a preliminary experience. J Headache Pain, 13, 537-541.

Patients suffering from headache are usually asked to use charts to allow monitoring of their disease. These diaries, providing they are regularly filled in, become crucial in the diagnosis and management of headache disorders because they provide further information on attack frequency and temporal pattern, drug intake, trigger factors, and short-/long-term responses to treatment. Electronic tools could facilitate diary monitoring and thus the management of headaches. Medication overuse headache (MOH) is a chronic and disabling condition that can be treated by withdrawing the overused drug(s) and adopting specific approaches that focus on the development of a close doctor-patient relationship in the post-withdrawal phase. Although the headache diary is, in this context, an essential tool for the constant, reliable monitoring of these patients to prevent relapses, very little is known about the applicability of electronic diaries in MOH patients. The purpose of this study was to evaluate the acceptability of and patient compliance with an electronic headache diary (palm device) as compared with a traditional diary chart in a group of headache inpatients with MOH. A palm diary device, developed in accordance with the ICHD-II criteria, was given to 85 MOH inpatients during the detoxification phase. On the first day of hospitalization, the patients were instructed in the use of the diary and were then required to fill it in daily for the following 7 days. Data on the patients’ opinions on the electronic diary and the instructions given, its screen and layout, as well as its convenience and ease of use, in comparison with the traditional paper version, were collected using a numerical rating scale. A total of 504 days with headache were recorded in both the electronic and the traditional headache diaries simultaneously. The level of patient compliance was good. The patients appreciated the electronic headache diary, deeming it easy to understand and to use (fill in); most of the patients rated the palm device handier than the traditional paper version

Baguet, J. P., Minville, C., Tamisier, R., Roche, F., Barone-Rochette, G., Ormezzano, O. et al. (2011). Increased aortic root size is associated with nocturnal hypoxia and diastolic blood pressure in obstructive sleep apnea. Sleep: Journal of Sleep and Sleep Disorders Research, 34, 1605-1607.

Study Objectives: Obstructive sleep apnea (OSA) is known as a major cardiovascular risk factor, and high prevalence of OSA has been reported in patients with thoracic aortic dissection. The aim of our study was to assess the relationship between OSA, its vascular consequences, and aortic root size. Design/Patients: 156 newly diagnosed apneic patients free of cardiovascular disease and medication were included. Patients underwent cardiac ultrasound for measuring aortic root diameter, polysomnography, office and 24-h ambulatory blood pressure (BP) measurements, baroreflex sensitivity (BRS), and arterial stiffness evaluation by carotid-to-femoral pulse wave velocity (PWV). Measurements and Results: In univariate analysis, greater aortic root size was associated with older age (P = 0.03) and severity of OSA as expressed by mean nocturnal oxygen saturation (SpOGéé) (P = 0.015). Moreover, greater aortic root size was associated with higher diastolic BP, measured both clinically (P = 0.0005) or by 24-h ambulatory BP monitoring (P = 0.02), and PWV (P = 0.03). Mean nocturnal SpOGéé was correlated with BRS (P = 0.0008), thus potentially influencing BP values and arterial stiffness. In multivariate stepwise regression analysis, diastolic BP was the only significant factor for aortic root size (P = 0.0003). Conclusions: In OSA patients, nocturnal hypoxemia decreased BRS and increased diastolic BP, which was the main factor influencing aortic root size.

Bailey, D. P., Fairclough, S. J., Savory, L. A., Denton, S. J., Pang, D., Deane, C. S. et al. (2012). Accelerometry-assessed sedentary behaviour and physical activity levels during the segmented school day in 10-14-year-old children: the HAPPY study. Eur.J Pediatr..

The school day offers several different time periods that provide varying opportunities for sedentary time (SED) and engagement in physical activity (PA), yet little is known about the PA and sedentary behaviour patterns of boys and girls during these times. The volume, intensity and temporal distributions of SED and PA undertaken by 135 schoolchildren aged 10-14 years, during different segments of the school day: (a) school transport, (b) morning recess, (c) lunch break, (d) class time and (e) after school, were explored using triaxial accelerometry. PA was categorised into SED, light PA (LPA), moderate PA (MPA) and vigorous PA (VPA). Girls engaged in significantly more SED and LPA than boys during recess and lunch break (p < 0.05), while boys engaged in significantly higher levels of VPA during recess (p < 0.001) and MPA and VPA during lunch break (p < 0.001). PA engagement was similar between sexes during other segments of the day. Conclusion: PA patterns appear more beneficial for health in boys during less structured school-based time periods and interventions may therefore target opportunities for girls to be physically active during these times to overcome this observed sex deficit

Bandini, L. G., Gleason, J., Curtin, C., Lividini, K., Anderson, S. E., Cermak, S. A. et al. (2012). Comparison of physical activity between children with autism spectrum disorders and typically developing children. Autism.

Regular physical activity is important for promoting health and well-being; however, physical activity behaviors in children with autism spectrum disorders (ASD) have received little attention. We compared physical activity levels among 53 children with ASD and 58 typically developing children aged 3-11 years who participated in the Children’s Activity and Meal Patterns Study (CHAMPS). After adjustment for age and sex the amount of time spent daily in moderate and vigorous activity was similar in children with ASD (50.0 minutes/day and typically developing children 57.1 minutes/day). However, parents reported that children with ASD participated in significantly fewer types of physical activities than did typically developing children (6.9 vs. 9.6, p <.0001) and spent less time annually participating in these activities than typically developing children (158 vs. 225 hours per year, p < 0.0001) after adjusting for age and sex. Although both groups of children engaged in similar levels of moderate and vigorous activity as measured by accelerometry, children with ASD engaged in fewer physical activities and for less time according to parental report, suggesting that some of the activity in children with ASD is not captured by standard questionnaire-based measures

Barnett, L. M., Hinkley, T., Okely, A. D., Hesketh, K., & Salmon, J. (2012). Use of electronic games by young children and fundamental movement skills? Percept.Mot.Skills, 114, 1023-1034.

This study investigated associations between pre-school children’s time spent playing electronic games and their fundamental movement skills. In 2009, 53 children had physical activity (Actigraph accelerometer counts per minute), parent proxy-report of child’s time in interactive and non-interactive electronic games (min./week), and movement skill (Test of Gross Motor Development-2) assessed. Hierarchical linear regression, adjusting for age (range = 3-6 years), sex (Step 1), and physical activity (cpm; M=687, SD=175.42; Step 2), examined the relationship between time in (a) non-interactive and (b) interactive electronic games and locomotor and object control skill. More than half (59%, n=31) of the children were female. Adjusted time in interactive game use was associated with object control but not locomotor skill. Adjusted time in non-interactive game use had no association with object control or locomotor skill. Greater time spent playing interactive electronic games is associated with higher object control skill proficiency in these young children. Longitudinal and experimental research is required to determine if playing these games improves object control skills or if children with greater object control skill proficiency prefer and play these games

Bassi, M. & Delle, F. A. (2012). Optimal experience among teachers: new insights into the work paradox. J Psychol., 146, 533-557.

Several studies highlighted that individuals perceive work as an opportunity for flow or optimal experience, but not as desirable and pleasant. This finding was defined as the work paradox. The present study addressed this issue among teachers from the perspective of self-determination theory, investigating work-related intrinsic and extrinsic motivation, as well as autonomous and controlled behavior regulation. In Study 1, 14 teachers were longitudinally monitored with Experience Sampling Method for one work week. In Study 2, 184 teachers were administered Flow Questionnaire and Work Preference Inventory, respectively investigating opportunities for optimal experience, and motivational orientations at work. Results showed that work-related optimal experiences were associated with both autonomous regulation and with controlled regulation. Moreover, teachers reported both intrinsic and extrinsic motivation at work, with a prevailing intrinsic orientation. Findings provide novel insights on the work paradox, and suggestions for teachers’ well-being promotion

Basterfield, L., Pearce, M. S., Adamson, A. J., Frary, J. K., Parkinson, K. N., Wright, C. M. et al. (2012). Physical activity, sedentary behavior, and adiposity in English children. American Journal of Preventive Medicine, 42, 445-451.

Background: The importance of variation in total volume of physical activity or moderate- to vigorous-intensity physical activity (MVPA) to development of body fatness in childhood is unclear, and it is unclear if physical activity has a greater influence on adiposity in boys than girls. Purpose: To assess relationships between 2-year changes in objectively measured physical activity, sedentary behavior, and adiposity in English children. Methods: Prospective cohort study, set in Northeast England, of a socioeconomically representative sample of 403 children. Measures were change in accelerometer-determined physical activity and sedentary behavior from age 7 to 9 years (data collected 2006/2007 and 2008/2009; analyzed in 2010) and concurrent change in adiposity (fat mass index derived from bioelectric impedance) and change in BMI Z-score. Results: Decline in MVPA was associated with a greater increase in fat mass index in boys but not girls. Declining MVPA was associated with increased BMI Z-score in boys but not girls. Increased sedentary behavior was not associated with increased BMI Z-score in either gender. Conclusions: Avoiding midGÇôlate childhood reductions in MVPA may reduce excessive fat gain, although such strategies may have greater impact on boys than girls.

Ben-Zeev, D., McHugo, G. J., Xie, H., Dobbins, K., & Young, M. A. (2012). Comparing retrospective reports to real-time/real-place mobile assessments in individuals with schizophrenia and a nonclinical comparison group. Schizophr.Bull., 38, 396-404.

Retrospective reports are often used as the primary source of information for important diagnostic decisions, treatment, and clinical research. Whether such reports accurately represent individuals’ past experiences in the context of a serious mental illness such as schizophrenia is unclear. In the current study, 24 individuals with schizophrenia and 26 nonclinical participants used a mobile device to complete multiple real-time/real-place assessments daily, over 7 consecutive days. At the end of the week, participants were also asked to provide a retrospective report summarizing the same period. Comparison of the data captured by the 2 methods showed that participants from both groups retrospectively overestimated the intensity of negative and positive daily experiences. In the clinical group, overestimations for affect were greater than for psychotic symptoms, which were relatively comparable to their retrospective reports. In both samples, retrospective reports were more closely associated with the week’s average than the most intense or most recent ratings captured with a mobile device. Multilevel modeling revealed that much of the variability in weekly assessments was not explained by between-person differences and could not be captured by a single retrospective estimate. Based on the findings of this study, clinicians and researchers should be aware that while retrospective summary reports of the severity of certain symptoms compare relatively well with average momentary ratings, they are limited in their ability to capture variability in one’s affective or psychotic experiences over time

Ben-Zeev, D. (2012). Mobile technologies in the study, assessment, and treatment of schizophrenia. Schizophrenia Bulletin, 38, 384-385.

The purpose of this special issue is to cultivate discussion about new opportunities for leveraging existing and emerging mobile technologies in the study of psychotic illnesses and to encourage investigators to think creatively about how these novel approaches can improve our understanding of the etiological risk factors, contextual influences, and possible treatments for schizophrenia. As mobile devices infiltrate more and more areas of life of the general population, they will undoubtedly become more prevalent among those with schizophrenia as well. Statistically, many of those who are currently growing up with these technologies in hand will go on to develop serious mental illnesses in the future. Looking forward, now is the opportune time for innovative investigators and clinicians to examine how these emerging technologies can be harnessed as a powerful new platform for research and treatment approaches that can be made available in the years ahead.

Berg, K. C., Crosby, R. D., Cao, L., Peterson, C. B., Engel, S. G., Mitchell, J. E. et al. (2012). Facets of Negative Affect Prior to and Following Binge-Only, Purge-Only, and Binge/Purge Events in Women With Bulimia Nervosa. J Abnorm.Psychol..

Ecological momentary assessment (EMA) data suggest that global negative affect (NA) increases prior to and decreases following episodes of binge eating and purging, providing support for the affect regulation model of BN. The current study examined whether facets of NA are differentially related to bulimic behaviors. Women with bulimia nervosa (BN; n = 133) completed a 2-week EMA protocol. Momentary assessments of 4 facets of NA (Fear, Guilt, Hostility, and Sadness) were derived from the PANAS subscales. Trajectories of the NA facets were modeled prior to and following binge-only, purge-only, and binge/purge events. Fear, Guilt, Hostility, and Sadness increased prior to and decreased following binge-only and binge/purge events. The same results were found for purge-only events, with the exception that Hostility did not increase significantly prior to purging. Notably, ratings of Guilt were higher than those of Fear, Hostility, and Sadness at the time of binge-only and binge/purge events. Furthermore, post hoc analyses demonstrate that Guilt increased prior to and decreased following the 3 behavior types, even after controlling for Fear, Hostility, and Sadness. These results provide further support for the affect regulation model of BN and also suggest that guilt may be particularly important to the pathology of BN.

Bhammar, D. M., Angadi, S. S., & Gaesser, G. A. (2012). Effects of Fractionized and Continuous Exercise on 24-h Ambulatory Blood Pressure. Med.Sci.Sports Exerc..

PURPOSE: To compare the effects of fractionized aerobic exercise (three 10-min exercise sessions) and continuous exercise (one 30-min exercise session) on 24-hour ambulatory blood pressure (ABP). METHODS: Eleven healthy prehypertensive subjects (28.3 +/- 8.0 (SD) yr) completed three randomly assigned conditions: 1) three 10-min sessions of aerobic exercise (3×10-min), 2) one continuous 30-min session of aerobic exercise (1×30-min), and 3) a non-exercise control trial (Control). The mode of exercise was walking on a motor-driven treadmill at 75% – 79% of maximum heart rate (HRmax) (60% – 65% VO2peak). Twenty-four hour ABP monitoring was monitored with an automated ABP device (Oscar 2). Linear mixed models were used to compare 24-h ABP responses between trials. RESULTS: Mean (+/- SD) 24-h systolic BP was significantly lower during the 3×10-min trial (127 +/- 15 mmHg) compared to Control (130 +/- 15 mmHg) (P < .001). Although both 3×10-min and 1×30-min reduced SBP compared to Control during daytime/evening (1300 h – 2300 h), only the 3×10-min reduced SBP during nighttime (2300 h – 0800 h; 118 +/- 16 mmHg vs. 122 +/- 14 mmHg; P = 0.024) and the following morning (0800 h – 1200 h; 127 +/- 15 mmHg vs. 131 +/- 15 mmHg; P = 0.016). Over 24-h, 26.7% of SBP values during 3×10-min were normal (i.e., <120 mmHg) compared to 18.3% for 1×30-min and 19.4% for control (P < 0.001). CONCLUSIONS: In prehypertensive individuals, fractionized exercise (e.g., three 10-min aerobic exercise sessions spread out evenly throughout the day) reduces 24-h systolic ABP by more than a single 30-min exercise session. Fractionized exercise may be a viable and effective exercise alternative to continuous exercise for cardiovascular risk reduction in this population

Bonomi, A. G., Plasqui, G., Goris, A. H. C., & Westerterp, K. R. (2012). Aspects of activity behavior as a determinant of the physical activity level. Scandinavian Journal of Medicine & Science in Sports, 22, 139-145.

This study investigated which aspects of the individuals’ activity behavior determine the physical activity level (PAL). Habitual physical activity of 20 Dutch adults (age: 26-60 years, body mass index: 24.5 -¦ 2.7 kg/m-¦) was measured using a tri-axial accelerometer. Accelerometer output was used to identify the engagement in different types of daily activities with a classification tree algorithm. Activity behavior was described by the daily duration of sleeping, sedentary behavior (lying, sitting, and standing), walking, running, bicycling, and generic standing activities. Simultaneously, the total energy expenditure (TEE) was measured using doubly labeled water. PAL was calculated as TEE divided by sleeping metabolic rate. PAL was significantly associated (P < 0.05) with sedentary time (R = GêÆ0.72), and the duration of walking (R = 0.49), bicycling (R = 0.77), and active standing (R = 0.62). A negative association was observed between sedentary time and the duration of active standing (R = GêÆ0.87; P < 0.001). A multiple-linear regression analysis showed that 75% of the variance in PAL could be predicted by the duration of bicycling (Partial R-¦ = 59%; P < 0.01), walking (Partial R-¦ = 9%; P < 0.05) and being sedentary (Partial R-¦ =7%; P < 0.05). In conclusion, there is objective evidence that sedentary time and activities related to transportation and commuting, such as walking and bicycling, contribute significantly to the average PAL.

Brandes, M., van Hees, V. T., Hannover, V., & Brage, S. (2012). Estimating Energy Expenditure from Raw Accelerometry in Three Types of Locomotion. Med.Sci.Sports Exerc..

PURPOSE: Accuracy of estimating activity-related energy expenditure (AEE) from raw body acceleration may improve by using prediction equations that are specific for the type of activity. The current study aims to improve published equations by deriving an equation for over-ground walking and to evaluate whether over-ground cycling and stair walking require specific prediction equations. METHODS: Participants (91M/95F, 8-81years) were equipped with a tri-axial accelerometer (DynaPort MiniMod) on their lower back. Total energy expenditure (TEE) was measured using a mobile oxygen analyzer (MetaMax 3b). Resting energy expenditure (REE) was measured over 30 min, following which a physical activity course was completed involving walking on level ground at slow (8 min), normal (8 min) and fast speed (3 min), stair-walking (3 min), and cycling (8 min). AEE was calculated as

Bruehl, S., Liu, X., Burns, J. W., Chont, M., & Jamison, R. N. (2012). Associations between daily chronic pain intensity, daily anger expression, and trait anger expressiveness: An ecological momentary assessment study. Pain.

Links between elevated trait anger expressiveness (anger-out) and greater chronic pain intensity are well documented, but pain-related effects of expressive behaviors actually used to regulate anger when it is experienced have been little explored. This study used ecological momentary assessment methods to explore prospective associations between daily behavioral anger expression and daily chronic pain intensity. Forty-eight chronic low back pain (LBP) patients and 36 healthy controls completed electronic diary ratings of momentary pain and behavioral anger expression in response to random prompts 4 times daily for 7days. Across groups, greater trait anger-out was associated with greater daily behavioral anger expression (P<0.001). LBP participants showed higher levels of daily anger expression than controls (P<0.001). Generalized estimating equation analyses in the LBP group revealed a lagged main effect of greater behavioral anger expression on increased chronic pain intensity in the subsequent assessment period (P<0.05). Examination of a traitxsituation model for anger-out revealed prospective associations between elevated chronic pain intensity and later increases in behavioral anger expression that were restricted largely to individuals low in trait anger-out (P<0.001). Traitxsituation interactions for trait anger suppression (anger-in) indicated similar influences of pain intensity on subsequent behavioral anger expression occurring among low anger-in persons (P<0.001). Overlap with trait and state negative affect did not account for study findings. This study for the first time documents lagged within-day influences of behavioral anger expression on subsequent chronic pain intensity. Trait anger regulation style may moderate associations between behavioral anger expression and chronic pain intensity

Burgin, C. J., Brown, L. H., Royal, A., Silvia, P. J., Barrantes-Vidal, N., & Kwapil, T. R. (2012). Being with others and feeling happy: Emotional expressivity in everyday life. Personality and Individual Differences, 53, 185-190.

An experience sampling study assessed the relation between psychological functioning in daily life and emotional expressivity as measured by the emotional expressivity scale (EES). Four hundred and twenty-nine participants carried personal digital assistants that signaled them 8 times daily to complete questionnaires assessing affect, activities, and social contact. As predicted, participants high in emotional expressivity were more likely to have elevated state positive affect, but not negative affect. These participants were also less likely to be alone and more likely to demonstrate better social functioning when with others. Cross-level interactions indicated that emotional expressivity moderated the association of social context and functioning in the moment. The findings support the validity of the EES as a measure of emotional expressivity and demonstrate the utility of experience sampling for describing personality traits in daily life.

Carrera, O., Adan, R. A. H., Gutierrez, E., Danner, U. N., Hoek, H. W., van Elburg, A. A. et al. (2012). Hyperactivity in Anorexia Nervosa: Warming up not just burning-off calories. PLoS One, 7.

Excessive physical activity is a common feature in Anorexia Nervosa (AN) that interferes with the recovery process. Animal models have demonstrated that ambient temperature modulates physical activity in semi-starved animals. The aim of the present study was to assess the effect of ambient temperature on physical activity in AN patients in the acute phase of the illness. Thirty-seven patients with AN wore an accelerometer to measure physical activity within the first week of contacting a specialized eating disorder center. Standardized measures of anxiety, depression and eating disorder psychopathology were assessed. Corresponding daily values for ambient temperature were obtained from local meteorological stations. Ambient temperature was negatively correlated with physical activity (p = GêÆ.405) and was the only variable that accounted for a significant portion of the variance in physical activity (p = .034). Consistent with recent research with an analogous animal model of the disorder, our findings suggest that ambient temperature is a critical factor contributing to the expression of excessive physical activity levels in AN. Keeping patients warm may prove to be a beneficial treatment option for this symptom.

Chaput, J.-P., Lambert, M., Mathieu, M.-E., Tremblay, M. S., O’ Loughlin, J., & Tremblay, A. (2012). Physical activity vs. sedentary time: Independent associations with adiposity in children. Pediatric Obesity, 7, 251-258.

Objective: To investigate the independent associations between objectively measured levels of movement intensity (i.e. time spent sedentary and at light, moderate and vigorous intensities) and indicators of adiposity in a cohort of Canadian children. Methods: A crossGÇÉsectional study was conducted in 550 Caucasian children aged 8GÇô10 years with at least one obese biological parent. Physical activity and sedentary time (accelerometer over 7 d) and indicators of adiposity (% body fat measured by dualGÇÉenergy XGÇÉray absorptiometry and waistGÇÉtoGÇÉheight ratio) were objectively measured. We examined the associations between levels of movement intensity and adiposity in multiGÇÉlevel linear regression models adjusted for age, sex, sleep duration, energy intake, sexual maturation, parental socioeconomic status and parental body mass index. Results: Objectively measured sedentary time was not associated with adiposity indicators in this cohort (unadjusted and adjusted models). However, moderateGÇÉtoGÇÉvigorous physical activity (MVPA) was inversely associated with % body fat (adj. +¦ = GêÆ0.047; P = 0.02) and waistGÇÉtoGÇÉheight ratio (adj. +¦ = GêÆ0.071; P < 0.001), independent of sedentary time and other covariates. Additionally, we observed that children who did not accumulate GëÑ60 min dGêÆ1 of MVPA were more likely to be overweight or obese compared to those who met the recommendation (odds ratio [OR] 2.22, 95% confidence interval [CI] 1.45GÇô3.38). In contrast, there was no difference in the likelihood of being categorized as overweight or obese between those who met the recommendation of Gëñ2 h d[sup]GêÆ1[/sup] of screen time and those who did not meet this recommendation (OR 1.27, 95% CI 0.75-2.01). Conclusion: The present study suggests that MVPA is independently associated with adiposity indices in this sample of children while sedentary time is not. Future studies should examine the best approach to increase MVPA in children and youth.

Clayton, A. H. (2012). eDiary and Female Sexual Distress Scale in evaluating distress in hypoactive sexual desire disorder (HSDD). Journal of Sexual Medicine, 9.

Assessment of sexual distress is an integral component in the diagnosis of female sexual dysfunction, and is measured as a patient-reported outcome. Three prospective, non-treatment, 4-week validation studies, two North American (N = 220; N = 255) and one European (N = 253), evaluated sexually related distress in women aged 18GÇô65 years with generalized, acquired hypoactive sexual desire disorder (HSDD), other types of female sexual dysfunction (FSD), and no FSD, as determined with a standard diagnostic interview by an expert clinician. Instruments evaluated include the 12-item Female Sexual Distress Scale (FSDS), the 13-item FSDS Revised (FSDS-R), and a single question about sexually related distress measured using a daily electronic diary (eDiary). The completion rate was >98% in all three studies, and 94% of the women recorded data at a >75% compliance rate. All three measures demonstrated significantly greater distress in women with HSDD when compared with women with no FSD. Levels of distress in women with other forms of FSD were comparable to the women with HSDD. In addition, a floor effect in improvement is also limiting. The short study period (4 weeks) is the primary limitation of this study. Discriminant validity was demonstrated in that all three measures confirmed more distress in women with HSDD vs. women with no FSD. Weekly and monthly measures showed a higher frequency of distress and less variability than daily measures.

Colley, R. C., Wong, S. L., Garriguet, D., Janssen, I., Gorber, S. C., & Tremblay, M. S. (2012). Physical activity, sedentary behaviour and sleep in Canadian children: parent-report versus direct measures and relative associations with health risk. Health Rep., 23, 45-52.

BACKGROUND: The accurate measurement of time devoted to physical activity, sedentary pursuits and sleep is difficult and varies considerably between surveys. This has implications for population surveillance and understanding how these variables relate to health. METHODS: This sample of children (n = 878) was from the 2007 to 2009 Canadian Health Measures Survey. Moderate- to-vigorous physical activity (MVPA), sedentary behaviour and sleep duration were assessed using both a questionnaire and an accelerometer. This article compared parent-reported and directly measured physical activity, sedentary behaviour and sleep, and examined their associations, alone or in combination, with selected health markers in children aged 6 to 11. RESULTS: According to parent reports, the children in this study had an average of 105 minutes of MVPA, 2.5 hours of screen time and 9.7 hours of sleep per day; accelerometers recorded 63 minutes of MVPA, 7.6 hours of sedentary time and 10.1 hours of sleep per day. MVPA, measured by parent-report or accelerometry, was significantly associated with body mass index. In a regression model, directly measured MVPA and sleep were significantly associated with body mass index, and directly measured MVPA was significantly associated with waist circumference. Parent-reported screen time approached a significant association with body mass index. INTERPRETATION: Time estimates and associations with health markers varied between parent-reported and directly measured physical activity, sedentary behaviour and sleep in children. These differences are important to understand before the two measurement techniques can be used interchangeably in research and health surveillance

Collip, D., Habets, P., Marcelis, M., Gronenschild, E., Lataster, T., Lardinois, M. et al. (2012). Hippocampal volume as marker of daily life stress sensitivity in psychosis. Psychol.Med., 1-11.

BACKGROUND: Reduced hippocampal size and increased stress sensitivity are associated with psychotic disorder and familial risk for psychosis. However, to what degree the hippocampus is implicated in daily life stress reactivity has not yet been examined. The current study investigated (i) whether familial risk (the contrast between controls, patients and siblings of patients) moderated the relationship between hippocampal volume (HV) and emotional daily stress reactivity and (ii) whether familial risk (the contrast between controls and siblings of patients) moderated the relationship between HV and cortisol daily stress reactivity. Method T1-weighted magnetic resonance imaging (MRI) scans were acquired from 20 patients with schizophrenia, 37 healthy siblings with familial risk for schizophrenia and 32 controls. Freesurfer 5.0.0 was used to measure HV. The experience sampling method (ESM), a structured momentary assessment technique, was used to assess emotional stress reactivity, that is the effect of momentary stress on momentary negative affect (NA). In addition, in the control and sibling groups, cortisol stress reactivity was assessed using momentary cortisol levels extracted from saliva. RESULTS: Multilevel linear regression analyses revealed a significant three-way interaction between group, HV and momentary stress in both the model of NA and the model of cortisol. Increased emotional stress reactivity was associated with smaller left HV in patients and larger total HV in controls. In line with the results in patients, siblings with small HV demonstrated increased emotional and cortisol stress reactivity compared to those with large HV. CONCLUSIONS: HV may index risk and possibly disease-related mechanisms underlying daily life stress reactivity in psychotic disorder

Conner, T. S. & Barrett, L. F. (2012). Trends in ambulatory self-report: The role of momentary experience in psychosomatic medicine. Psychosomatic Medicine, 74, 327-337.

In this article, we review the differences between momentary, retrospective, and trait self-report techniques and discuss the unique role that ambulatory reports of momentary experience play in psychosomatic medicine. After a brief historical review of self-report techniques, we discuss the latest perspective that links ambulatory self-reports to a qualitatively different conscious selfGÇöthe “experiencing self “GÇöwhich is functionally and neuroanatomically different from the “remembering” and “believing” selves measured through retrospective and trait questionnaires. The experiencing self functions to navigate current environments and is relatively more tied to the salience network and corporeal information from the body that regulates autonomic processes. As evidence, we review research showing that experiences measured through ambulatory assessment have stronger associations with cardiovascular reactivity, cortisol response, immune system function, and threat/reward biomarkers compared with memories or beliefs. By contrast, memories and beliefs play important roles in decision making and long-term planning, but they are less tied to bodily processes and more tied to default/long-term memory networks, which minimizes their sensitivity for certain research questions. We conclude with specific recommendations for using self-report questionnaires in psychosomatic medicine and suggest that intensive ambulatory assessment of experiences may provide greater sensitivity for connecting psychological with biologic processes.

Cook, J. E., Calcagno, J. E., Arrow, H., & Malle, B. F. (2012). Friendship trumps ethnicity (but not sexual orientation): Comfort and discomfort in inter-group interactions. British Journal of Social Psychology, 51, 273-289.

An experience sampling study tested the degree to which interactions with out-group members evoked negative affect and behavioural inhibition after controlling for level of friendship between partners. When friendship level was statistically controlled, neither White nor Black participants reported feeling more discomfort interacting with ethnic out-group members compared to ethnic in-group members. When partners differed in sexual orientation, friendship level had a less palliating effect. Controlling for friendship, both gay and straight menGÇöbut not womenGÇöfelt more behaviourally inhibited when interacting with someone who differed in sexual orientation, and heterosexual participants of both genders continued to report more negative affect with gay and lesbian interaction partners. However, gay and lesbian participants reported similar levels of negative affect interacting with in-group (homosexual) and out-group (heterosexual) members after friendship level was controlled. Results suggest that much of the discomfort observed in inter-ethnic interactions may be attributable to lower levels of friendship with out-group partners. The discomfort generated by differences in sexual orientation, however, remains a more stubborn barrier to comfortable intergroup interactions.

Crayen, C., Eid, M., Lischetzke, T., Courvoisier, D. S., & Vermunt, J. K. (2012). Exploring dynamics in mood regulation-Mixture latent Markov modeling of ambulatory assessment data. Psychosomatic Medicine, 74, 366-376.

Objective: To illustrate how fluctuation patterns in ambulatory assessment data with features such as few categorical items, measurement error, and heterogeneity in the change pattern can adequately be analyzed with mixture latent Markov models. The identification of fluctuation patterns can be of great value to psychosomatic research concerned with dysfunctional behavior or cognitions, such as addictive behavior or noncompliance. In our application, unobserved subgroups of individuals who differ with regard to their mood regulation processes, such as mood maintenance and mood repair, are identified. Methods: In an ambulatory assessment study, mood ratings were collected 56 times during 1 week from 164 students. The pleasant-unpleasant mood dimension was assessed by the two ordered categorical items unwell-well and bad-good. Mixture latent Markov models with different number of states, classes, and degrees of invariance were tested, and the best model according to information criteria was interpreted. Results: Two latent classes that differed in their mood regulation pattern during the day were identified. Mean classification probabilities were high (90.88) for this model. The larger class showed a tendency to stay in and return to a moderately pleasant mood state, whereas the smaller class was more likely to move to a very pleasant mood state and to stay there with a higher probability. Conclusions: Mixture latent Markov models are suitable to obtain information about interindividual differences in stability and change in ambulatory assessment data. Identified mood regulation patterns can serve as reference for typical mood fluctuation in healthy young adults.

Cullum, J., O’Grady, M., Armeli, S., & Tennen, H. (2012). The role of context-specific norms and group size in alcohol consumption and compliance drinking during natural drinking events. Basic and Applied Social Psychology, 34, 304-312.

We examined how group size and context-specific drinking norms corresponded to alcohol consumption and compliance with drinking offers using experience sampling methods. For 30 days, 397 college students reported daily on their alcohol consumption and social-context during natural social drinking events. Larger groups corresponded with greater alcohol consumption, but only when context-specific norms were high. Furthermore, larger groups increased compliance with drinking offers when norms were high but decreased compliance with drinking offers when norms were low. Thus, subtle features of the social-context may influence not only overall consumption behavior but also compliance with more overt forms of social influence.

Dopp, R. R., Mooney, A. J., Armitage, R., & King, C. (2012). Exercise for adolescents with depressive disorders: a feasibility study. Depress.Res Treat., 2012, 257472.

Objectives. Adolescence is associated with increased depressive symptoms and decreased aerobic exercise, yet the relationship between exercise and clinical depression among adolescents requires further examination. This study assessed the feasibility of a 12-week intervention designed to increase exercise for adolescents with depressive disorders: Will a teenager with depression exercise? Methods. Participants were 13 adolescents with depression reporting low levels of aerobic exercise. They completed a 12-week intervention (15 supervised exercise sessions and 21 independent sessions). Exercise was measured through the aerobic exercise Questionnaire, actigraphy, and heart-rate monitoring. Depression was measured with the Children’s Depression Rating Scale, Revised, and Quick Inventory of Depressive Symptomatology, Self-Report. Results. All participants who started the intervention completed the protocol, attending all supervised exercise sessions. Actigraphy verified 81% adherence to the protocol’s independent sessions. Analysis of secondary outcomes showed a significant increase in exercise levels and a significant decrease in depression severity. Initially, ten participants were overweight or obese, and three were healthy weight. After 12 weeks of exercise, the number of participants in the healthy-weight category doubled. Conclusions. Adolescents suffering from depression can complete a rigorous protocol requiring structured increases in aerobic exercise. Participants showed significant increases in exercise, and significant decreases in depressive symptoms

Dunton, G. F., Liao, Y., Kawabata, K., & Intille, S. (2012). Momentary assessment of adults’ physical activity and sedentary behavior: feasibility and validity. Front Psychol., 3, 260.

Introduction: Mobile phones are ubiquitous and easy to use, and thus have the capacity to collect real-time data from large numbers of people. Research tested the feasibility and validity of an Ecological Momentary Assessment (EMA) self-report protocol using electronic surveys on mobile phones to assess adults’ physical activity and sedentary behaviors. Methods: Adults (N = 110; 73% female, 30% Hispanic, 62% overweight/obese) completed a 4-day signal-contingent EMA protocol (Saturday-Tuesday) with eight surveys randomly spaced throughout each day. EMA items assessed current activity (e.g., Watching TV/Movies, Reading/Computer, Physical Activity/Exercise). EMA responses were time-matched to minutes of moderate-to-vigorous physical activity (MVPA) and sedentary activity (SA) measured by accelerometer immediately before and after each EMA prompt. Results: Unanswered EMA prompts had greater MVPA (+/-15 min) than answered EMA prompts (p = 0.029) for under/normal weight participants, indicating that activity level might influence the likelihood of responding. The 15-min. intervals before versus after the EMA-reported physical activity (n = 296 occasions) did not differ in MVPA (p > 0.05), suggesting that prompting did not disrupt physical activity. SA decreased after EMA-reported sedentary behavior (n = 904 occasions; p < 0.05) for overweight and obese participants. As compared with other activities, EMA-reported physical activity and sedentary behavior had significantly greater MVPA and SA, respectively, in the +/-15 min of the EMA prompt (ps < 0.001), providing evidence for criterion validity. Conclusion: Findings generally support the acceptability and validity of a 4-day signal-contingent EMA protocol using mobile phones to measure physical activity and sedentary behavior in adults. However, some MVPA may be missed among underweight and normal weight individuals

Dunton, G. F., Intille, S. S., Wolch, J., & Pentz, M. A. (2012). Children’s perceptions of physical activity environments captured through ecological momentary assessment: A validation study. Preventive Medicine: An International Journal Devoted to Practice and Theory, 55, 119-121.

Objective: This study used ecological momentary assessment (EMA) to investigate whether children’s perceptions of physical activity (PA) settings correspond with (1) parents’ perceptions of neighborhood characteristics (convergent construct validity) and (2) children’s level of PA in those settings (concurrent criterion validity). Methods: Low-to-middle income, ethnically-diverse children (N = 108) (ages 9GÇô13) living in Southern California participated in 8 days of EMA during non-school time. EMA measured current activity type (e.g., sports/exercise, TV watching) and perceptions of the current setting (i.e., vegetation, traffic, safety). The Neighborhood Environment Walkability Survey (NEWS) assessed parents’ perceptions of neighborhood characteristics. EMA responses were time-matched to moderate-to-vigorous physical activity (MVPA) (measured by accelerometer) in the 30 min before and after each EMA survey. Data were collected in 2009GÇô2010. Results: Children’s perceptions of vegetation and traffic in PA settings corresponded with parents’ perceptions of the aesthetics (OR = 2.21, 95% CI = 1.04GÇô4.73) and traffic (OR = 2.64, 95% CI = 1.31GÇô5.30) in neighborhood environment, respectively. MVPA minutes were higher in settings perceived by children to have less traffic (+¦ = 3.47, p < .05). Conclusions: This work provides initial support for the construct and criterion validity of EMA-based measures of children’s perceptions of their PA environments.

Finan, P. H., Tennen, H., Thoemmes, F., Zautra, A. J., & Davis, M. C. (2012). Ambulatory monitoring in genetics of psychosomatic medicine. Psychosomatic Medicine, 74, 349-355.

Psychosomatic disorders are composed of an array of psychological, biologic, and environmental features. The existing evidence points to a role for genetic factors in explaining individual differences in the development and maintenance of a variety of disorders, but studies to date have not shown consistent and replicable effects. As such, the attempt to uncover individual differences in the expression of psychosomatic disorders as a function of genetic architecture requires careful attention to their phenotypic architecture or the various intermediate phenotypes that make up a heterogeneous disorder. Ambulatory monitoring offers a novel approach to measuring time-variant and situation-dependent intermediate phenotypes. Recent examples of the use of ambulatory monitoring in genetic studies of stress reactivity, chronic pain, alcohol use disorders, and psychosocial resilience are reviewed in an effort to highlight the benefits of ambulatory monitoring for genetic study designs.

Finan, P. H. (2012). Genetic influences on the dynamics of pain and affect in fibromyalgia. ProQuest Information & Learning, US.

Fibromyalgia (FM) is a chronic musculoskeletal disorder characterized by widespread pain, fatigue, and a variety of other comorbid physiological and psychological characteristics, including a deficit of positive affect. Recently, the focus of research on the pathophysiology of FM has considered the role of a number of genomic variants. In the current manuscript, case-control analyses did not support the hypothesis that FM patients would differ from other chronic pain groups in catechol-O-methyltransferase (COMT) and mu-opioid receptor (OPRM1) genotype. However, evidence is provided in support of the hypothesis that functional single nucleotide polymorphisms on the COMT and OPRM1 genes would be associated with risk and resilience, respectively, in a dual processing model of pain-related positive affective regulation in FM. Forty-six female patients with a physician-confirmed diagnosis of FM completed an electronic diary that included once-daily assessments of positive affect and soft tissue pain. Multilevel modeling yielded a significant gene X environment interaction, such that individuals with met/met genotype on COMT experienced a greater decline in positive affect as daily pain increased than did either val/met or val/val individuals. A gene X environment interaction for OPRM1 also emerged, indicating that individuals with at least one asp allele were more resilient to elevations in daily pain than those homozygous for the asn allele. In sum, the findings offer researchers ample reason to further investigate the contribution of the catecholamine and opioid systems, and their associated genomic variants, to the still poorly understood experience of FM.

Floro, J. N. (2012). Reduced regulation of negative emotion with escalations in smoking behavior during high school: A dose-response effect. ProQuest Information & Learning, US.

Recent research suggests that cigarette smoking is associated with developing externalizing and internalizing psychological disorders. Because reduced emotion regulation is also associated with developing externalizing and internalizing disorders, and because cigarette smoking and nicotine addiction are theorized to interfere with emotion regulation processes, the association between cigarette smoking and psychological disorders may be mediated by reduced emotion regulation. This is the first study to examine the relationship between escalations in cigarette smoking behavior and emotion regulation. In a secondary analysis of electronic diary data from a multi-cohort, longitudinal observation study of high school students, the present study tested whether cigarette smoking was associated with reduced regulation of anger, sadness, anxiety, and happiness. Semiannually across the 4 high school years, students completed electronic diaries during 4 consecutive days. For each of these 4-day waves, smoking status was categorized as nonsmoking, infrequent smoking, or light-to-moderate smoking behavior. Daily emotion regulation was measured by area under the curve (AUC) and then averaged over a 4-day monitoring wave. AUC is a composite measure of emotion intensity, lability, and duration. A total of 178 male (55.6%) and female (44.4%) participants were included. Within-subject testing of the relationship between escalations in cigarette smoking behavior and 4-day wave measures of emotion regulation was done through repeated measures logistic regression modeling (Proc Genmod, SAS). Through forward selecting, stepwise model building, the present study attempted to control for sex, age, and freshman year externalizing and internalizing levels. Escalations in cigarette smoking behavior were associated with reductions in regulation of anger and sadness. A similar trend was found for anxiety but not at a statistically significant level. Escalations in cigarette smoking behavior were not associated with reductions in regulation of happiness. These findings indicate that adolescents become less adept at regulating their negative emotions as they progress in cigarette smoking behavior from nonsmoking to light-to-moderate smoking. These smoking-related reductions in regulation of negative emotion occur at subclinical levels of nicotine addiction. Further, these smoking-related reductions in regulation of negative emotion may put adolescents at risk for developing externalizing and internalizing disorders such as conduct disorder or depression, respectively.

Fredricks, J. A. & McColskey, W. (2012). The measurement of student engagement: A comparative analysis of various methods and student self-report instruments. In S.L.Christenson, A. L. Reschly, & C. Wylie (Eds.), Handbook of research on student engagement (pp. 763-782). New York, NY US: Springer Science + Business Media.

(from the chapter) One of the challenges with research on student engagement is the large variation in the measurement of this construct, which has made it challenging to compare findings across studies. This chapter contributes to our understanding of the measurement of student in engagement in three ways. First, we describe strengths and limitations of different methods for assessing student engagement (i.e., self-report measures, experience sampling techniques, teacher ratings, interviews, and observations). Second, we compare and contrast 11 self-report survey measures of student engagement that have been used in prior research. Across these 11 measures, we describe what is measured (scale name and items), use of measure, samples, and the extent of reliability and validity information available on each measure. Finally, we outline limitations with current approaches to measurement and promising future directions.

Gaggioli, A. (2012). Quality of experience in real and virtual environments: some suggestions for the development of positive technologies. Stud.Health Technol.Inform., 181, 177-181.

What does one feel when one uses virtual reality? How does this experience differ from the experience associated with “real life” activities and situations? To answer these questions, we used the Experience Sampling Method (ESM), a procedure that allows researchers to investigate the daily fluctuations in the quality of experience through on-line self reports that participants fill out during daily life. The investigation consisted in one-week ESM observation (N = 42). During this week, participants underwent two virtual reality sessions: Immediately after the exposure to virtual environments, they were asked to complete a ESM report. For data analysis, experiential variables were aggregated into four dimensions: Mood, Engagement, Confidence, and Intrinsic Motivation Intrinsic Motivation. Findings showed that virtual experience is characterized by a specific configuration, which comprises significantly positive values for affective and cognitive components. In particular, positive scores of Mood suggest that participants perceived VR as an intrinsically pleasurable activity, while positive values of Engagement indicate that the use of VR and the experimental task provided valid opportunities for action and high skill investment. Furthermore, results showed that virtual experience is associated with Flow, a state of consciousness characterized by narrowed focus of attention, deep concentration, positive affect and intrinsic reward. Implications for VR research and practice are discussed

Galland, B. C., Kennedy, G. J., Mitchell, E. A., & Taylor, B. J. (2012). Algorithms for using an activity-based accelerometer for identification of infant sleep-wake states during nap studies. Sleep Medicine, 13, 743-751.

Objective: To determine the accuracy of using different algorithms on the output from an Actical accelerometer, a device normally used to measure physical activity, to distinguish sleep from wake states. Methods: Thirty-one infants aged 10GÇô22 weeks wore the accelerometer on the shin for a daytime nap recording in tandem with polysomnography. SleepGÇôwake epochs were identified using four computations/algorithms: the zero-threshold computation, two common algorithms used for wrist-based devices (Sadeh and Cole), and a new algorithm developed for this study (count-scaled). Accuracy was examined in direct epoch comparison with polysomnography using 15-, 30- and 60-s sampling epochs. Results: Overall agreements (accuracy) for sleepGÇôwake states were > 80% for all computations. The count-scaled algorithm sampling 15-s epochs gave the highest accuracy, with sensitivity (sleep agreement) at 86% and specificity (awake agreement) at 85%. Other computations yielded higher sensitivity at the expense of specificity. Another way to assess the accuracy of identification of sleepGÇôwake states was to compare sleep parameter outputs. All computations and sampling epochs were significantly correlated with total sleep time (r =0.76GÇô0.88), sleep latency (r =0.70GÇô0.93), sleep efficiency (r =0.76GÇô0.87), and wake time after sleep onset (r =0.41GÇô0.53). The number of awakenings after sleep onset was overestimated by accelerometry. Conclusions: The Actical accelerometer, designed to measure physical activity, can reliably identify sleep in infants during napping, with the count-scaled algorithm showing some advantages over other methods for accurate identification of sleepGÇôwake epochs.

Gass, J. C., Wray, J. M., Hawk, L. W., Mahoney, M. C., & Tiffany, S. T. (2012). Impact of varenicline on cue-specific craving assessed in the natural environment among treatment-seeking smokers. Psychopharmacology, 223, 107-116.

Rationale: Varenicline is believed to work, in part, by reducing craving responses to smoking cues and by reducing general levels of craving; however, these hypotheses have never been evaluated with craving assessed in the natural environments of treatment-seeking smokers. Objectives: Ecological momentary assessment procedures were used to assess the impact of varenicline on cue-specific and general craving in treatment-seeking smokers prior to quitting. Methods: For 5 weeks prior to quitting, 60 smokers carried personal digital assistants that assessed their response to smoking or neutral cues. During week 1 (baseline), participants did not receive medication; during weeks 2GÇô4 (drug manipulation), participants were randomized to receive varenicline or placebo; during week 5 (standard therapy), all participants received varenicline. Craving was assessed before each cue; cue-specific craving and attention to cue were assessed after each cue. Results: During all phases, smoking cues elicited greater craving than neutral cues; the magnitude of this effect declined after the first week. General craving declined across each phase of the study. Relative to the placebo condition, varenicline was associated with a greater decline in general craving over the drug manipulation phase. Varenicline did not significantly attenuate cue-specific craving during any phase of the study. Conclusions: Smoking cues delivered in the natural environment elicited strong craving responses in treatment-seeking smokers, but cue-specific craving was not affected by varenicline administered prior to the quit attempt. These findings suggest that the clinical efficacy of varenicline is not mediated by changes in cue-specific craving during the pre-quit period of treatment-seeking smokers.

Gay, V. & Leijdekkers, P. (2012). Personalised mobile health and fitness apps: lessons learned from myFitnessCompanion(R). Stud.Health Technol.Inform., 177, 248-253.

Smartphones and tablets are slowly but steadily changing the way we look after our health and fitness. Today, many high quality mobile apps are available for users and health professionals and cover the whole health care chain, i.e. information collection, prevention, diagnosis, treatment and monitoring. Our team has developed a mobile health and fitness app called myFitnessCompanion(R) which has been available via Android market since February 2011. The objective of this paper is to share our experience with rolling out a mobile health and fitness app. We discuss the acceptance of health apps by end-users and healthcare industry. We discuss how mobile health apps will be distributed in the near future, the use of Personal Health Record (PHR) systems such as Microsoft HealthVault and the impact of regulations (FDA) on the future of mobile health apps. The paper is based on seven years of experience by the authors as mobile health and fitness application developers and we discuss the challenges and opportunities for app developers in the health industry

Giesbrecht, G. F., Letourneau, N., Campbell, T., & Kaplan, B. J. (2012). Affective experience in ecologically relevant contexts is dynamic and not progressively attenuated during pregnancy. Arch.Womens Ment.Health.

Pregnancy is thought to diminish a woman’s appraisal of and affective response to stressors. To examine this assumption, we used an electronic diary and an ecological momentary assessment strategy to record women’s (n = 85) experiences of positive and negative affect five times each day over 2 days within each trimester of pregnancy. The women also completed the Edinburgh Postnatal Depression Scale in each trimester. Multilevel modeling indicated nonlinear patterns for both positive and negative affect that differed by the level of depressive symptoms. The findings suggest that changes in the psychological experience over the course of pregnancy are dynamic and not progressively attenuated

Goldschmidt, A. B., Peterson, C. B., Wonderlich, S. A., Crosby, R. D., Engel, S. G., Mitchell, J. E. et al. (2012). Trait-level and momentary correlates of bulimia nervosa with a history of anorexia nervosa. Int.J Eat.Disord..

OBJECTIVE: Some investigators have suggested subtyping bulimia nervosa (BN) by anorexia nervosa (AN) history. We examined trait-level and momentary eating-related and psychosocial factors in BN with and without an AN history. METHOD: Interview, questionnaire, and ecological momentary assessment data of eating-related and psychological symptoms were collected from 122 women with BN, including 43 with (BN+) and 79 without an AN history (BN-). RESULTS: Body mass index (kg/m(2) ) was lower in BN+ than BN- (p = 0.001). Groups did not differ on trait-level anxiety, shape/weight concerns, psychiatric comorbidity, or dietary restraint; or on momentary anxiety, dietary restriction, binge eating, purging, or exercise frequency, or affective patterns surrounding binge/purge behaviors. Negative affect increased prior to exercise and decreased thereafter in BN+ but not BN-, although groups did not statistically differ. DISCUSSION: Results do not support formally subtyping BN by AN history. Exercise in BN+ may modulate negative affect, which could have important treatment implications. (c) 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)

Gorzelniak, L., Dias, A., Schultz, K., Wittmann, M., Karrasch, S., Jorres, R. A. et al. (2012). Comparison of Recording Positions of Physical Activity in Patients with Severe COPD Undergoing LTOT. COPD., 9, 528-537.

Background: Accelerometry is increasingly used to assess physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD). It is not known how the relationship of PA to clinical results depends on the position of the PA sensor. Methods: We assessed the effect of monitor position by measuring lower extremity (ankle), upper extremity (wrist) and total body movement (hip) in 52 patients with severe COPD (mean [+/- SD] age, 62 +/- 10 years; FEV(1), 38 +/- 12% predicted) undergoing long-term oxygen therapy with and without walkers during a pulmonary rehabilitation (PR) program. Sensors were worn 8.5 +/- 3.1 days and data was compared to the BODE score and the 6-minute walk distance (6MWD) assessed at the beginning and end of the PR. Results: Mean ankle PA was moderately related to the 6MWD, irrespective of patients being equipped with a walker or not (p < 0.05). Mean PA values were considerably lower in COPD patients with walker compared to patients without for all sensor positions. No significant association was observed between mean hip PA data and 6MWD; however, hip and ankle PA data were moderately related in walker-free and strongly related in walker patients (p < 0.01). In a multivariate regression model only ankle activity was significantly associated with the BODE score (p < 0.01). Conclusion: The sensor position had a significant impact on the association between PA recordings and the 6MWD in very severe COPD. In our setting, ankle measurement seemed to best reflect the clinical state of patients

Granholm, E., Ben-Zeev, D., Link, P. C., Bradshaw, K. R., & Holden, J. L. (2012). Mobile Assessment and Treatment for Schizophrenia (MATS): A pilot trial of an interactive text-messaging intervention for medication adherence, socialization, and auditory hallucinations. Schizophrenia Bulletin, 38, 414-425.

Mobile Assessment and Treatment for Schizophrenia (MATS) employs ambulatory monitoring methods and cognitive behavioral therapy interventions to assess and improve outcomes in consumers with schizophrenia through mobile phone text messaging. Three MATS interventions were developed to target medication adherence, socialization, and auditory hallucinations. Participants received up to 840 text messages over a 12-week intervention period. Fifty-five consumers with schizophrenia or schizoaffective disorder were enrolled, but 13 consumers with more severe negative symptoms, lower functioning,and lower premorbid IQ did not complete the intervention, despite repeated prompting and training. For completers, the average valid response rate for 216 outcome assessment questions over the 12-week period was 86%, and 86% of phones were returned undamaged. Medication adherence improved significantly, but only for individuals who were living independently. Number of social interactions increased significantly and a significant reduction in severity of hallucinations was found. In addition, the probability of endorsing attitudes that could interfere with improvement in these outcomes was also significantly reduce din MATS. Lab-based assessments of more general symptoms and functioning did not change significantly. This pilot study demonstrated that low-intensity text-messaging interventions like MATS are feasible and effective interventions to improve several important outcomes, especially for higher functioning consumers with schizophrenia.

Gregoski, M. J., Vertegel, A., Shaporev, A., & Treiber, F. A. (2012). Tension Tamer: Delivering Meditation With Objective Heart Rate Acquisition for Adherence Monitoring Using a Smart Phone Platform. J Altern.Complement Med..

Objectives: This brief report demonstrates the proof of concept of the Tension Tamer (TT) smartphone application, which integrates photoplethysmograph capabilities with breathing awareness meditation (BAM), to reduce stress and measure heart rate and adherence. Design: Methods for objectively measuring heart rate and adherence to BAM were developed as part of a future randomized controlled trial. Setting/Location: The study was conducted at Jerry Zucker Middle School of Science and the Medical University of South Carolina, Charleston. Subjects: The subjects were three prehypertensive male teachers. Intervention: The method used was smartphone delivered BAM. Outcome measures: Objective measures included heart rate, adherence, and ambulatory blood pressure (BP). Results: Adherence data was successfully collected by the TT application. Increased adherence to TT coincided with increased improvements in ambulatory BP over a 3-month period. Conclusions: TT shows promise as a simple inexpensive program for administering BAM and capturing adherence data in future clinical trials

Gunter, J. D. (2012). Examining experience in depressed and nondepressed individuals. ProQuest Information & Learning, US.

The inner experience of nine depressed and nine nondepressed individuals was explored using Descriptive Experience Sampling. Each participant completed four days of descriptive experience sampling, exploring about six moments of their inner experience on each sampling day. Although the Depressed participants self-reported substantially higher levels of depressive symptomatology on the Center for Epidemiological Studies Depression scale (CES-D) on each day of sampling, the differences in the frequency of depressive symptomatology in the inner experiences of these two groups were not statistically significant. Despite the group differences not reaching statistical significance, the Depressed group experienced somewhat more frequent moments of depression, anxiety, fatigue, body discomfort, negative feelings, negative content, and fewer instances of positive feelings and content than the Nondepressed group. The two groups experienced the five most frequent phenomena of inner experience identified in prior DES studies (inner seeing, inner speaking, unsymbolized thinking, feelings, and sensory awareness) at similar rates. Moments reflecting constructs related to depression, such as Beck’s Negative Cognitive Triad, were either very infrequent or absent. Overall, differences in the inner experience of the depressed and nondepressed participants observed via descriptive experience sampling were much less pronounced than the differences in their global self-reports of depressive symptomatology via the CES-D. The implications and possible reasons for this are discussed.

Habets, P., Collip, D., Myin-Germeys, I., Gronenschild, E., van Bronswijk, S., Hofman, P. et al. (2012). Pituitary volume, stress reactivity and genetic risk for psychotic disorder. Psychological Medicine, 42, 1523-1533.

Background: HypothalamicG ÇôpituitaryGÇôadrenal (HPA) axis hyperactivity, associated with increased pituitary volume, may mediate observed alterations in stress reactivity in patients with psychotic disorder. We examined the association between pituitary volume, real-life stress reactivity and genetic liability for psychotic disorder. Method: Pituitary volumes were derived from magnetic resonance imaging (MRI) scans of 20 patients with psychotic disorder, 37 non-psychotic siblings of these patients, and 32 controls. The Experience Sampling Method (ESM) was used to measure emotional stress reactivity [changes in negative affect (NA) associated with daily life stress] in the three groups, and biological stress reactivity (changes in cortisol associated with daily life stress) in siblings and controls. Interactions between group, stress and pituitary volume in models of NA and cortisol were examined. Results: Groups did not differ in pituitary volume. Patients showed significantly higher emotional stress reactivity than siblings and controls. In addition, emotional stress reactivity increased with increasing pituitary volume to a greater degree in patients than in controls and siblings. Siblings had higher cortisol levels than controls but did not show increased cortisol reactivity to stress. There was no interaction between pituitary volume, stress and group in the model of cortisol. Conclusions: Higher pituitary volume was associated with increased emotional stress reactivity in patients with psychotic disorder, siblings and controls. The association was significantly stronger in the patient group, suggesting a process of progressive sensitization mediating clinical outcome.

Heron, K. E. & Smyth, J. M. (2012). Is intensive measurement of body image reactive? A two-study evaluation using Ecological Momentary Assessment suggests not. Body Image.

Intensive assessment methods (e.g., Ecological Momentary Assessment [EMA]) are increasingly used to capture body image experiences in daily life. One concern with EMA is multiple assessments may increase reactivity to internal or external cues, potentially biasing measurement. Reactivity to EMA was evaluated in two studies (Study 1: N=63 female undergraduates, Study 2: N=131 women with high body dissatisfaction/disordered eating). Participants completed five daily surveys on handheld computers for 1-2 weeks and body image-related questionnaires at the start and end of each study. Results showed no systematic changes in pre- and post-EMA measures or momentary EMA reports, suggesting women were not reactive to the EMA protocols. Completing 1-2 weeks of EMA does not appear to affect body dissatisfaction, mood, or attitudes in non-clinical or at-risk samples of women. These studies provide evidence that EMA methods can be used to assess real-world body image experiences without undue concern about measurement reactivity

Hinkley, T., O’Connell, E., Okely, A. D., Crawford, D., Hesketh, K., & Salmon, J. (2012). Assessing Volume of Accelerometry Data for Reliability in Preschool Children. Med.Sci.Sports Exerc..

PURPOSE: This study examines what volume of accelerometry data (hours/days) is required to reliably estimate preschool children’s physical activity and whether it is necessary to include weekday and weekend data. METHODS: Accelerometry data from 493-799 (depending on wear-time) preschool children from the Melbourne-based Healthy Active Preschool Years study were utilized. Percent of wear-time each child spent in total (light-vigorous) physical activity was the main outcome. Hourly increments of daily data were analyzed. T-tests, controlling for age and clustering by centre of recruitment, assessed differences between weekday and weekend physical activity. Intraclass correlation coefficients estimated reliability for an individual day. Spearman-Brown Prophecy Formula estimated number of days required to reach reliability estimates of 0.7, 0.8 and 0.9. RESULTS: Children spent a significantly greater percent of time being physically active on weekend compared with week days regardless of the minimum number of hours included (t=12.49-16.76, P<0.001 for all). The number of days required to reach each of the predetermined reliability estimates increased as the number of hours of data per day decreased. For instance, 2.7-2.8 days of data were required to reach a reliability estimate of 0.7 with 10 or more hours of data per day; 3.3-3.4 days were required to meet the same reliability estimate for days with seven hours of data. CONCLUSIONS: Future studies should ensure they include the minimum amount of data (hours/day and number of days) as identified in this study to meet at least a 0.7 reliability level and should report the level of reliability for their study. In addition to weekdays, at least one weekend day should be included in analyses to reliably estimate physical activity levels for preschool children

Hislop, J. F., Bulley, C., Mercer, T. H., & Reilly, J. J. (2012). Comparison of epoch and uniaxial versus triaxial accelerometers in the measurement of physical activity in preschool children: a validation study. Pediatr.Exerc.Sci., 24, 450-460.

The objectives of this study were to explore whether triaxial is more accurate than uniaxial accelerometry and whether shorter sampling periods (epochs) are more accurate than longer epochs. Physical activity data from uniaxial and triaxial (RT3) devices were collected in 1-s epochs from 31 preschool children (15 males, 16 females, 4.4 +/- 0.8 yrs) who were videoed while they engaged in 1-hr of free-play. Video data were coded using the Children’s Activity Rating Scale (CARS). A significant difference (p < .001) in the number of minutes classified as moderate to vigorous physical activity (MVPA) was found between the RT3 and the CARS (p < .002) using the cut point of relaxed walk. No significant difference was found between the GT1M and the CARS or between the RT3 and the CARS using the cut point for light jog. Shorter epochs resulted in significantly greater overestimation of MVPA, with the bias increasing from 0.7 mins at 15-s to 3.2 mins at 60-s epochs for the GT1M and 0 mins to 1.7 mins for the RT3. Results suggest that there was no advantage of a triaxial accelerometer over a uniaxial model. Shorter epochs result in significantly higher number of minutes of MVPA with smaller bias relative to direct observation

Hofmann, W., Vohs, K. D., & Baumeister, R. F. (2012). What people desire, feel conflicted about, and try to resist in everyday life. Psychological Science, 23, 582-588.

In the present study, we used experience sampling to measure desires and desire regulation in everyday life. Our analysis included data from 205 adults, who furnished a total of 7,827 reports of their desires over the course of a week. Across various desire domains, results revealed substantial differences in desire frequency and strength, the degree of conflict between desires and other goals, and the likelihood of resisting desire and the success of this resistance. Desires for sleep and sex were experienced most intensively, whereas desires for tobacco and alcohol had the lowest average strength, despite the fact that these substances are thought of as addictive. Desires for leisure and sleep conflicted the most with other goals, and desires for media use and work brought about the most self-control failure. In addition, we observed support for a limited-resource model of self-control employing a novel operationalization of cumulative resource depletion: The frequency and recency of engaging in prior self-control negatively predicted peopleGÇÖs success at resisting subsequent desires on the same day.

Huang, P. H. & Weng, L. J. (2012). Estimating the reliability of aggregated and within-person centered scores in ecological momentary assessment. Multivariate Behavioral Research, 47, 421-441.

A procedure for estimating the reliability of test scores in the context of ecological momentary assessment (EMA) was proposed to take into account the characteristics of EMA measures. Two commonly used test scores in EMA were considered: the aggregated score (AGGS) and the within-person centered score (WPCS). Conceptually, AGGS and WPCS represent the interindividual differences and the intraindividual differences, respectively. The reliability coefficients for AGGS and WPCS were derived using a multilevel factor model with a serial correlation structure framework. Point estimates and confidence intervals of these coefficients were obtained using Mx (Neale, Boker, Xie, & Maes, 2004). A simulation study showed that the proposed procedure performed well empirically. Diary data from Huang (2009), which recorded daily joy level of 110 undergraduate students for 8 days, was used to illustrate the applicability of the proposed method.

Jacobs, N., Menne-Lothmann, C., Derom, C., Thiery, E., van, O. J., & Wichers, M. (2012). Deconstructing the familiality of variability in momentary negative and positive affect. Acta Psychiatr.Scand..

Jacobs N, Menne-Lothmann C, Derom C, Thiery E, van Os J, Wichers M. Deconstructing the familiality of variability in momentary negative and positive affect. Objective: The daily life, affective phenotypes of momentary negative affect (NA), positive affect (PA) variability and NA variability are associated with future depressive symptomatology. This study investigates the extent to which genetic and environmental factors contribute to the inter-individual differences in these daily life, affective phenotypes. Method: Two hundred and seventy-nine female twins from the Flemish (Belgium) general population participated in an experience sampling study measuring affect in daily life. Structural equation modelling was used to fit univariate and bivariate models. Results: Genetic factors explained, respectively, 18%, 18% and 35% of the inter-individual differences in momentary NA, PA variability and NA variability. Non-shared environmental factors were found to explain the remaining inter-individual variation. In addition, 41% of the association between positive and NA variability was attributed to shared genetic factors. Conclusion: Results of this study show that daily life patterns of affective expression are subject to substantial environmental influence. Prospective assessments of the effect of interventions on these expressions may therefore represent a powerful tool to prevent transition from subclinical depressive symptomatology to a clinical outcome or to reduce symptomatology in those with clinical depression

Jiang, L. (2012). Absence makes the heart grow fonder, behaviors adaptive and perceptions idealized: The effects of geographic separation and interpersonal media on intimacy process. ProQuest Information & Learning, US.

Many people assume that it is challenging to maintain a romantic relationship when the partners are separated by a considerable distance. Recent research on long-distance relationships, however, suggests that long-distance romantic relationships are equally or even more intimate and satisfied than geographically close counterparts. The present study examined whether the everyday intimacy process unfolds differently in long-distance versus geographically close dating relationships and whether the use of interpersonal media interplays with geographic separation to affect intimacy in specific interactions. Drawing on the Interpersonal Process Model of Intimacy (IPMI; Reis & Shaver, 1988), the study tested an intimacy enhancement mechanism in which long-distance couples engage in more adaptive self-disclosure behaviors and form more idealized relationship perceptions than do geographically close couples for the pursuit of intimacy across various interpersonal media. These predictions were examined with a novel electronic diary method. Long-distance and geographically close dating couples completed a 7-day diary study in which both members of the couple independently reported their interactions that took place each day. The results provide support for the behavioral adaptation and perceptual idealization effects proposed, and suggest that the two effects vary along the media dimensions of cue multiplicity, synchronicity and mobility. These findings offer a contextual extension to the IPMI and advance the understanding of communication and relational processes in long-distance and mixed-mode relationships.

Kamarck, T. W., Shiffman, S., Sutton-Tyrrell, K., Muldoon, M. F., & Tepper, P. (2012). Daily psychological demands are associated with 6-year progression of carotid artery atherosclerosis: The Pittsburgh Healthy Heart Project. Psychosomatic Medicine, 74, 432-439.

Objective: We examine associations between the perception of ongoing psychological demands by ecological momentary assessment (EMA) and 6-year changes in carotid artery atherosclerosis by ultrasonography. Methods: A total of 270 initially healthy participants collected ambulatory blood pressure (ABP) and recorded their daily experiences, using electronic diaries, during two 3-day periods. Mean intima-media thickness (IMT) and plaque were assessed in the carotid arteries using B-mode ultrasound at baseline and again during a 6-year follow-up (mean follow-up duration = 73 months). Results: Among those who had no exposure to antihypertensive medications during the course of follow-up (n = 192), daily psychological demands were associated with greater progression of IMT as well as plaque, after adjusting for demographic and risk factor covariates. Associations between demands and plaque change were partially accounted for by ABP differences among those reporting high demands. Among those who were employed at baseline (n = 117), 6-year IMT changes were more strongly associated with ratings of daily demands than with traditional measures of occupational stress. Conclusions: These data support the role of psychological demands as a correlate of subclinical atherosclerotic progression, they point to ABP as a potential mechanism facilitating these effects, and they highlight the utility of EMA measures for capturing daily psychological demands with potential effects on health.

Kaplan, R. M. & Stone, A. A. (2012). Bringing the Laboratory and Clinic to the Community: Mobile Technologies for Health Promotion and Disease Prevention. Annu.Rev.Psychol..

Health-related information collected in psychological laboratories may not be representative of people’s everyday health. For at least 70 years, there has been a call for methods that sample experiences from everyday environments and circumstances. New technologies, including cell phones, sensors, and monitors, now make it possible to collect information outside of the laboratory in environments representative of everyday life. We review the role of mobile technologies in the assessment of health-related behaviors, physiological responses, and self-reports. Ecological momentary assessment offers a wide range of new opportunities for ambulatory assessment and evaluation. The value of mobile technologies for interventions to improve health is less well established. Among 21 randomized clinical trials evaluating interventions that used mobile technologies, more than half failed to document significant improvements on health outcomes or health risk factors. Theoretical and practical issues for future research are discussed.

Karr, T. M., Crosby, R. D., Cao, L., Engel, S. G., Mitchell, J. E., Simonich, H. et al. (2012). Posttraumatic stress disorder as a moderator of the association between negative affect and bulimic symptoms: an ecological momentary assessment study. Compr.Psychiatry.

OBJECTIVE: The purpose of this study was to examine the potential moderating effect of posttraumatic stress disorder (PTSD) on the emotion-behavior relationship in individuals with bulimia nervosa (BN). METHOD: A total of 119 women with BN were involved in the study. Participants were divided into 2 groups: those with BN and PTSD (n = 20) and those with BN only (n = 99). Ecological momentary assessment procedures were used for the examination of affect, frequency of bulimic behaviors, and the relationship of affect and bulimic behavior over time. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders was conducted for the diagnosis of BN, PTSD, mood disorders, anxiety disorders, and substance use disorders. Mood disorders, anxiety disorders, and substance use disorders functioned as covariates in all analyses. RESULTS: Statistical models showed that those in the PTSD group reported a greater daily mean level of negative affect (NA) and a greater daily frequency of bulimic behaviors than those in the BN-only group. Moderation was found for the association between NA and time in that the PTSD group showed a faster acceleration in NA before purging and faster deceleration in NA after purging. The association between positive affect and time was also moderated by group, indicating that the PTSD group had a faster acceleration in positive affect after purging than the BN-only group. CONCLUSION: These findings highlight the importance of recognizing PTSD when interpreting the emotion-behavior relationship in individuals with BN

Kikuchi, H., Yoshiuchi, K., Yamamoto, Y., Komaki, G., & Akabayashi, A. (2012). Diurnal variation of tension-type headache intensity and exacerbation: An investigation using computerized ecological momentary assessment. Biopsychosoc.Med., 6, 18.

BackgroundsTension-type headache is a common psychosomatic disease. However, diurnal variation of headache is yet to be clarified, perhaps due to the lack of an appropriate method to investigate it. Like other painful diseases, it would be helpful to know if there is diurnal variation in tension-type headaches, both for managing headaches and understanding their pathophysiology. The aim of this study was to determine if there is diurnal variation in the intensity and exacerbation of tension-type headache. METHODS: Patients (N = 31) with tension-type headache recorded for one week their momentary headache intensity several times a day and their acute headache exacerbations using a watch-type computer as an electronic diary (computerized ecological momentary assessment). Multilevel modeling was used to test the effects of time of day on momentary headache intensity and on the occurrence of acute exacerbations. RESULTS: A significant diurnal variation in momentary headache intensity was shown (P = 0.0005), with the weakest headaches in the morning and a peak in the late afternoon. A between-individual difference in the diurnal pattern was suggested. On-demand medication use was associated with a different diurnal pattern (P = 0.025), suggesting that headache intensity decreases earlier in the evening in subjects who used on-demand medication, while headache subtype, prophylactic medication use, and sex were not associated with the difference. The occurrence of acute headache exacerbation also showed a significant diurnal variation, with a peak after noon (P = 0.0015). CONCLUSIONS: Tension-type headache was shown to have a significant diurnal variation. The relation to pathophysiology and psychosocial aspects needs to be further explored

Kim, J., Kikuchi, H., & Yamamoto, Y. (2012). Systematic comparison between ecological momentary assessment and day reconstruction method for fatigue and mood states in healthy adults. Br.J Health Psychol..

OBJECTIVES: While both ecological momentary assessment (EMA) and the day reconstruction method (DRM) have been used to overcome recall bias, a full systematic comparison of these methods has not been conducted. This study was aimed to investigate the differences and correlations between momentary fatigue and mood states recorded by EMA and reconstructed ones recorded by simultaneous DRM in healthy adults. DESIGN: Each of two different designs (time-based and episode-based) of EMA and DRM were simultaneously conducted. METHODS: Twenty-five healthy adults recorded momentary fatigue and mood states with EMA, and then, reconstructed them with DRM. Differences between the mean and the variability of momentary and reconstructed recordings, and the correlations between them, are analysed for different EMA designs. RESULTS: No significant differences are found between the mean or the variability of EMA and DRM estimated over the monitoring period. However, correlations between EMA and DRM are low, albeit statistically significant. CONCLUSIONS: Although the overall mean and variability of EMA recordings may be accessible with DRM, detailed changes over time of momentary fatigue and mood states are not retrieved by DRM. Statement of contribution What is already known on this subject? Day reconstruction method (DRM) may be a reliable substitute strategy for the measurement of subjective symptoms instead of ecological momentary assessment (EMA). Remembering the context of daily activities with DRM is assumed to be helpful in reconstructing subjective symptoms without recall bias. What this study adds? We are not able to reconstruct our diurnal time course (i.e. detailed changes over time) of subjective symptoms (e.g. fatigue and mood states in this study) with DRM, while their approximate mean and overall variability during the study period may be accessible with DRM. Reconstructed depression by DRM could be biased when the subjects remembered whether their behaviour was active or inactive

Kim, S. Y. & Kim, J. S. (2012). Investigating stage-sequential growth mixture models with multiphase longitudinal data. Structural Equation Modeling, 19, 293-319.

This article investigates three types of stage-sequential growth mixture models in the structural equation modeling framework for the analysis of multiple-phase longitudinal data. These models can be important tools for situations in which a single-phase growth mixture model produces distorted results and can allow researchers to better understand population heterogeneity and growth over multiple phases. Through theoretical and empirical comparisons of the models, the authors discuss strategies with respect to model selection and interpreting outcomes. The unique attributes of each approach are illustrated using ecological momentary assessment data from a tobacco cessation study. Transitional discrepancy between phases as well as growth factors are examined to see whether they can give us useful information related to a distal outcome, abstinence at 6 months postquit. It is argued that these statistical models are powerful and flexible tools for the analysis of complex and detailed longitudinal data.

Kimhy, D., Myin-Germeys, I., Palmier-Claus, J., & Swendsen, J. (2012). Mobile assessment guide for research in schizophrenia and severe mental disorders. Schizophrenia Bulletin, 38, 386-395.

Mobile assessment techniques have been used for nearly 3 decades in mental health research, including in investigations of individuals with schizophrenia and other severe disorders. This article reviews the benefits of these data collection strategies relative to traditional self-report or clinician-administered measures administered in hospital or laboratory settings. A detailed discussion of the technical decisions facing researchers in the field is then presented, covering study design issues, questionnaire content development, and choices in hardware and software selection. Following these points, sample recruitment and retention strategies are discussed, as well as the main statistical issues that are necessary to consider in the exploitation of repeated measures data generated by this methodology.

Kolodyazhniy, V., Spati, J., Frey, S., Gotz, T., Wirz-Justice, A., Krauchi, K. et al. (2012). An improved method for estimating human circadian phase derived from multichannel ambulatory monitoring and artificial neural networks. Chronobiol.Int., 29, 1078-1097.

Recently, we developed a novel method for estimating human circadian phase with noninvasive ambulatory measurements combined with subject-independent multiple regression models and a curve-fitting approach. With this, we were able to estimate circadian phase under real-life conditions with low subject burden, i.e., without need of constant routine (CR) laboratory conditions, and without measuring standard circadian markers, such as core body temperature (CBT) or pineal hormone melatonin rhythms. The precision of ambulatory-derived estimated circadian phase was within an error of 12 +/- 41 min (mean +/- SD) in comparison to melatonin phase during a CR protocol. The physiological measures could be reduced to a triple combination: skin temperatures, irradiance in the blue spectral band of ambient light, and motion acceleration. Here, we present a nonlinear regression model approach based on artificial neural networks for a larger data set (25 healthy young males), including both the original data and additional data collected in the same protocol and using the same equipment. Throughout our validation study, subjects wore multichannel ambulatory monitoring devices and went about their daily routine for 1 wk. The devices collected a large number of physiological, behavioral, and environmental variables, including CBT, skin temperatures, cardiovascular and respiratory functions, movement/posture, ambient temperature, spectral composition and intensity of light perceived at eye level, and sleep logs. After the ambulatory phase, study volunteers underwent a 32-h CR protocol in the laboratory for measuring unmasked circadian phase (i.e., “midpoint” of the nighttime melatonin rhythm). To overcome the complex masking effects of many different confounding variables during ambulatory measurements, neural network-based nonlinear regression techniques were applied in combination with the cross-validation approach to subject-independent prediction of circadian phase. The most accurate estimate of circadian phase with a prediction error of -3 +/- 23 min (mean +/- SD) was achieved using only two types of the measured variables: skin temperatures and irradiance for ambient light in the blue spectral band. Compared to our previous linear multiple regression modeling approach, motion acceleration data can be excluded and prediction accuracy, nevertheless, improved. Neural network regression showed statistically significant improvement of variance of prediction error over traditional approaches in determining circadian phase based on single predictors (CBT, motion acceleration, or sleep logs), even though none of these variables was included as predictor. We, therefore, have identified two sets of noninvasive measures that, combined with the prediction model, can provide researchers and clinicians with a precise measure of internal time, in spite of the masking effects of daily behavior. This method, here validated in healthy young men, requires testing in a clinical or shiftwork population suffering from circadian sleep-wake disorders. (Author correspondence: vitaliy.kolodyazhniy@sbg.ac.at )

Kubiak, T. & Stone, A. A. (2012). Ambulatory monitoring of biobehavioral processes in health and disease. Psychosomatic Medicine, 74, 325-326.

Ambulatory monitoring techniques have a long tradition in the study of biobehavioral processes and psychosomatic medicine. This is evidenced in several important publications in Psychosomatic Medicine dating back to the first half of the last century, which use ambulatory monitoring, ranging from ambulatory blood pressure monitoring to elucidate the white-coat and masked hypertension effects to carefully designed studies that use diary techniques for the assessment of self-reports of symptoms, behaviors, and attitudes. Our reasons for undertaking the endeavor of guest editing this special issue on ambulatory monitoring in Psychosomatic Medicine are straightforward. In the past decade, ambulatory monitoring has advanced in several respects that are highly relevant to biobehavioral research. In this special issue, we opted for the broad term of ambulatory monitoring, encompassing diary self-reports and physiological monitoring. This special issue is organized into three sections. The first section is devoted to current trends in ambulatory monitoring, including state-of-the-art review articles and research with novel ambulatory approaches. The second section revolves around statistical issues and topics in data analysis, a field that saw rapid advances in the past years. In the third section, three selected domains are addressed: ambulatory monitoring of social environments and interactions, monitoring of salivary cortisol, and multimodal ambulatory monitoring in behavioral cardiology. The articles compiled in this issue provide a valuable resource for research involving ambulatory monitoring approaches. These ambulatory measures are critical to the understanding of biobehavioral processes in health and disease and will lead to new theories in psychosomatic medicine and other areas where the behavioral and social sciences interact with biomedical research.

Kudielka, B. M., Gierens, A., Hellhammer, D. H., Wust, S., & Schlotz, W. (2012). Salivary cortisol in ambulatory assessment-Some dos, some don’ts, and some open questions. Psychosomatic Medicine, 74, 418-431.

The impact of stress on health and disease is an important research topic in psychosomatic medicine. Because research on hypothalamic-pituitary-adrenal (HPA) axis regulation under controlled laboratory studies lacks ecological validity, it needs to be complemented by a research program that includes momentary ambulatory assessment. The measurement of salivary cortisol offers the possibility to trace the free steroid hormone concentrations in ambulant settings. Therefore, in this article, we first discuss the role of salivary cortisol in ambulatory monitoring. We start with a brief description of HPA axis regulation, and we then consider cortisol assessments in other organic materials, followed by a presentation of common salivary markers of HPA axis regulation suitable for ambulatory assessment. We further provide an overview on assessment designs and sources of variability within and between subjects (intervening variables), acknowledge the issue of (non)compliance, and address statistical aspects. We further give an overview of associations with psychosocial and health-related variables relevant for ambulatory assessment. Finally, we deal with preanalytical aspects of laboratory salivary cortisol analysis. The relative simplicity of salivary cortisol assessment protocols may lead to an overoptimistic view of the robustness of this method. We thus discuss several important issues related to the collection and storage of saliva samples and present empirical data on the stability of salivary cortisol measurements over time.

Le, G. D., Crosby, R. D., Engel, S. G., Cao, L., Ndungu, A., Crow, S. J. et al. (2012). DSM-IV-Defined Anorexia Nervosa Versus Subthreshold Anorexia Nervosa (EDNOS-AN). Eur.Eat.Disord.Rev..

OBJECTIVES: Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder, yet its heterogeneity begs less reliance on this broad diagnostic category. The purpose of this study was to compare women with anorexia nervosa (AN) and EDNOS, AN type (EDNOS-AN) from a multisite study on eating-related and general psychopathology measures. METHODS: One hundred eighteen participants (n = 59 with DSM-IV AN, n = 59 with EDNOS-AN) completed structured interviews, questionnaires and a physical examination at baseline. In addition, participants carried a handheld palm pilot computer for 2 weeks to provide ecological momentary assessment (EMA) information about mood and eating disorder behaviours. RESULTS: No significant differences between AN and EDNOS-AN were found on the self-report and interview measures, or on the EMA mood assessments. The only differences to emerge were that participants with AN reported higher rates of binge eating and purging on EMA compared with those with EDNOS-AN, whereas EDNOS-AN reported higher rates of checking thighs and joints on EMA compared with those with AN. For the physiological parameters, AN presented with lower white blood cell counts compared with EDNOS-AN. CONCLUSIONS: Findings highlight the clinical significance of EDNOS-AN and support a closer look at the definition of AN as proposed by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Copyright (c) 2012 John Wiley & Sons, Ltd and Eating Disorders Association

Lepage, M. L., Price, M., O’Neil, P., & Crowther, J. H. (2012). The effect of exercise absence on affect and body dissatisfaction as moderated by obligatory exercise beliefs and eating disordered beliefs and behaviors. Psychol.Sport Exerc., 13, 500-508.

AIM: Research suggests that exercise absence is frequently associated with greater guilt and negative affect, particularly when obligatory exercise beliefs and eating disordered psychopathology are considered. Two separate studies used ecological momentary assessment (EMA) to examine differences in mood on exercise and non-exercise days and the moderating impact of obligatory exercise beliefs and eating disordered beliefs and behaviors. METHOD: Both studies recruited female university students who endorsed frequent exercise behavior and study two also recruited based on level of eating disordered psychopathology. Participants completed the Obligatory Exercise Questionnaire at baseline and EMA measures of affect and exercise behavior for approximately one week. Study two participants also completed measures of body dissatisfaction and cognitions. RESULTS: Results of study one suggest that obligation to exercise appears to have a greater impact on general level of affect than does exercise absence or the interaction of these two. In addition, in study two, eating disorder symptomatology was significantly associated with affect and cognition while exercise absence and obligatory exercise beliefs were not. CONCLUSIONS: The present studies suggest that the absence of exercise is not associated with significant changes in affect or cognitions. However, obligation to exercise and eating disorder symptomatology do impact affect and cognitions

Li, X. & Hedeker, D. (2012). A three-level mixed-effects location scale model with an application to ecological momentary assessment data. Stat.Med..

In studies using ecological momentary assessment (EMA), or other intensive longitudinal data collection methods, interest frequently centers on changes in the variances, both within-subjects and between-subjects. For this, Hedeker et al. (Biometrics 2008; 64: 627-634) developed an extended two-level mixed-effects model that treats observations as being nested within subjects and allows covariates to influence both the within-subjects and between-subjects variance, beyond their influence on means. However, in EMA studies, subjects often provide many responses within and across days. To account for the possible systematic day-to-day variation, we developed a more flexible three-level mixed-effects location scale model that treats observations within days within subjects, and allows covariates to influence the variance at the subject, day, and observation level (over and above their usual effects on means) using a log-linear representation throughout. We provide details of a maximum likelihood solution and demonstrate how SAS PROC NLMIXED can be used to achieve maximum likelihood estimates in an alternative parameterization of our proposed three-level model. The accuracy of this approach using NLMIXED was verified by a series of simulation studies. Data from an adolescent mood study using EMA were analyzed to demonstrate this approach. The analyses clearly show the benefit of the proposed three-level model over the existing two-level approach. The proposed model has useful applications in many studies with three-level structures where interest centers on the joint modeling of the mean and variance structure. Copyright (c) 2012 John Wiley & Sons, Ltd

Mehl, M. R., Robbins, M. L., & Deters, F. G. (2012). Naturalistic observation of health-relevant social processes: The electronically activated recorder methodology in psychosomatics. Psychosomatic Medicine, 74, 410-417.

This article introduces a novel observational ambulatory monitoring method called the electronically activated recorder (EAR). The EAR is a digital audio recorder that runs on a handheld computer and periodically and unobtrusively records snippets of ambient sounds from participantsGÇÖ momentary environments. In tracking moment-to-moment ambient sounds, it yields acoustic logs of peopleGÇÖs days as they naturally unfold. In sampling only a fraction of the time, it protects participantsGÇÖ privacy and makes large observational studies feasible. As a naturalistic observation method, it provides an observerGÇÖs account of daily life and is optimized for the objective assessment of audible aspects of social environments, behaviors, and interactions (e.g., habitual preferences for social settings, idiosyncratic interaction styles, subtle emotional expressions). This article discusses the EAR method conceptually and methodologically, reviews prior research with it, and identifies three concrete ways in which it can enrich psychosomatic research. Specifically, it can a) calibrate psychosocial effects on health against frequencies of real-world behavior; b) provide ecological observational measures of health-related social processes that are independent of self-report; and c) help with the assessment of subtle and habitual social behaviors that evade self-report but have important health implications. An important avenue for future research lies in merging traditional self-report-based ambulatory monitoring methods with observational approaches such as the EAR to allow for the simultaneous yet methodologically independent assessment of inner, experiential aspects (e.g., loneliness) and outer, observable aspects (e.g., social isolation) of real-world social processes to reveal their unique effects on health.

Meltzer, L. J., Walsh, C. M., Traylor, J., & Westin, A. M. L. (2012). Direct comparison of two new actigraphs and polysomnography in children and adolescents. Sleep: Journal of Sleep and Sleep Disorders Research, 35, 159-166.

Study Objectives: To evaluate the validity and reliability of 2 new models of commercially available actigraphs compared to polysomnography for children and adolescents. Design and Setting: Subjects concurrently wore the Ambulatory Monitoring Inc. Motionlogger Sleep Watch (AMI) and the Phillips Respironics Mini-Mitter Actiwatch-2 (PRMM) while undergoing overnight polysomnography (PSG) in a pediatric sleep laboratory housed in a tertiary care childrenGÇÖs hospital. Participants: 115 youth (59 girls, 56 boys), ages 3-18 years (mean 8.8 years, SD 4.4 years). Measurements: Outcome variables were total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). Epoch-by-epoch comparisons were made between the 2 devices and PSG to determine sensitivity, specificity, and accuracy. Agreement between the 2 devices was determined with t-tests and the Bland-Altman concordance technique. Different algorithms/sensitivities, developmental age groups, and sleep disordered breathing (SDB) status were also examined. Results: For both device brands, sensitivity (0.89-0.97), specificity (0.54-0.77), and accuracy (0.87-0.90) were similar to previous reports. Notably, compared to PSG, both device brands significantly overestimated WASO, while the AMI device also significantly underestimated TST. Inter-device comparison of the 2 brands found poor agreement for TST, WASO, and SE. Agreement with PSG differed depending on the scoring algorithm (AMI) or sensitivity setting (PRMM), as well as across developmental age group and sleep disordered breathing (SDB) status. Conclusions: Similar to previous reports, both new actigraph brands were found to have good sensitivity (to detect sleep), but poorer specificity (to detect wake). Study results also suggest that researchers should adjust the scoring algorithm/sensitivity depending on a study’s design (e.g., young children vs. adolescents, healthy children vs. youth with SDB). Further, inter-device reliability was poor, suggesting the need for caution when comparing results across studies that use different brands of actigraphic devices.

Menne-Lothmann, C., Jacobs, N., Derom, C., Thiery, E., van, O. J., & Wichers, M. (2012). Genetic and environmental causes of individual differences in daily life positive affect and reward experience and its overlap with stress-sensitivity. Behav.Genet., 42, 778-786.

Momentary positive affect (PA) and reward experience may underlie subjective wellbeing, and index mental health resilience. This study examines their underlying sources of variation and the covariation with stress-sensitivity. The experience sampling method was used to collect multiple appraisals of mood and daily life events in 520 female twins. Structural equation model fitting was employed to determine sources of variation of PA, reward experience, and the association between reward experience and stress-sensitivity. PA was best explained by shared and non-shared environmental factors, and reward experience by non-shared environmental factors only, although the evidence was also suggestive of a small genetic contribution. Reward experience and stress-sensitivity showed no association. PA was not heritable. Most-if not all-variance of reward experience was explained by environmental influences. Stress-sensitivity, indexing depression vulnerability, and reward experience were non-overlapping, suggesting that resilience traits are independent from stress-sensitivity levels in a general population sample

Morelli, S. A., Rameson, L. T., & Lieberman, M. D. (2012). The neural components of empathy: Predicting daily prosocial behavior. Soc.Cogn Affect.Neurosci..

Previous neuroimaging studies on empathy have not clearly identified neural systems that support the three components of empathy: affective congruence, perspective-taking, and prosocial motivation. These limitations stem from a focus on a single emotion per study, minimal variation in amount of social context provided, and lack of prosocial motivation assessment. In the current investigation, 32 participants completed a functional magnetic resonance imaging session assessing empathic responses to individuals experiencing painful, anxious, and happy events that varied in valence and amount of social context provided. They also completed a 14-day experience sampling survey that assessed real-world helping behaviors. The results demonstrate that empathy for positive and negative emotions selectively activates regions associated with positive and negative affect, respectively. In addition, the mirror system was more active during empathy for context-independent events (pain), whereas the mentalizing system was more active during empathy for context-dependent events (anxiety, happiness). Finally, the septal area, previously linked to prosocial motivation, was the only region that was commonly activated across empathy for pain, anxiety, and happiness. Septal activity during each of these empathic experiences was predictive of daily helping. These findings suggest that empathy has multiple input pathways, produces affect-congruent activations, and results in septally mediated prosocial motivation

Murphy, S. L., Kratz, A. L., Williams, D. A., & Geisser, M. E. (2012). The Association between Symptoms, Pain Coping Strategies, and Physical Activity Among People with Symptomatic Knee and Hip Osteoarthritis. Front Psychol., 3, 326.

Effective use of coping strategies by people with chronic pain conditions is associated with better functioning and adjustment to chronic disease. Although the effects of coping on pain have been well studied, less is known about how specific coping strategies relate to actual physical activity patterns in daily life. The purpose of this study was to evaluate how different coping strategies relate to symptoms and physical activity patterns in a sample of adults with knee and hip osteoarthritis (OA; N = 44). Physical activity was assessed by wrist-worn accelerometry; coping strategy use was assessed by the Chronic Pain Coping Inventory. We hypothesized that the use of coping strategies that reflect approach behaviors (e.g., Task Persistence), would be associated with higher average levels of physical activity, whereas avoidance coping behaviors (e.g., Resting, Asking for Assistance, Guarding) and Pacing would be associated with lower average levels of physical activity. We also evaluated whether coping strategies moderated the association between momentary symptoms (pain and fatigue) and activity. We hypothesized that higher levels of approach coping would be associated with a weaker association between symptoms and activity compared to lower levels of this type of coping. Multilevel modeling was used to analyze the momentary association between coping and physical activity. We found that higher body mass index, fatigue, and the use of Guarding were significantly related to lower activity levels, whereas Asking for Assistance was significantly related to higher activity levels. Only Resting moderated the association between pain and activity. Guarding, Resting, Task Persistence, and Pacing moderated the association between fatigue and activity. This study provides an initial understanding of how people with OA cope with symptoms as they engage in daily life activities using ecological momentary assessment and objective physical activity measurement

Myers, T. A., Ridolfi, D. R., Crowther, J. H., & Ciesla, J. A. (2012). The impact of appearance-focused social comparisons on body image disturbance in the naturalistic environment: The roles of thin-ideal internalization and feminist beliefs. Body Image, 9, 342-351.

Drawing on Festinger’s (1954) social comparison theory and its modern applications, this research investigated the relationship between upward appearance-focused social comparisons and body image disturbance using ecological momentary assessment, which allows for examination of these phenomena in their natural context. Participants were 91 undergraduate women who answered questionnaires five times per day for five days using Palm Personal Data Assistant (PDA) devices. Analyses were conducted using hierarchical linear modeling, which allows for examination of longitudinal data both within and across participants. Results revealed a positive relationship between upward appearance-focused social comparisons and body image disturbance. Upward appearance-focused social comparisons were associated with greater body image disturbance for those with higher levels of thin-ideal internalization and with greater body checking for women with lower levels of feminist beliefs. These findings further illuminate the nature of the relationship between social comparisons and body image disturbance.

Nishiguchi, S., Yamada, M., Nagai, K., Mori, S., Kajiwara, Y., Sonoda, T. et al. (2012). Reliability and validity of gait analysis by Android-based smartphone. Telemedicine and e-Health, 18, 292-296.

Smartphones are very common devices in daily life that have a built-in tri-axial accelerometer. Similar to previously developed accelerometers, smartphones can be used to assess gait patterns. However, few gait analyses have been performed using smartphones, and their reliability and validity have not been evaluated yet. The purpose of this study was to evaluate the reliability and validity of a smartphone accelerometer. Thirty healthy young adults participated in this study. They walked 20m at their preferred speeds, and their trunk accelerations were measured using a smartphone and a tri-axial accelerometer that was secured over the L3 spinous process. We developed a gait analysis application and installed it in the smartphone to measure the acceleration. After signal processing, we calculated the gait parameters of each measurement terminal: peak frequency (PF), root mean square (RMS), autocorrelation peak (AC), and coefficient of variance (CV) of the acceleration peak intervals. Remarkable consistency was observed in the testGÇôretest reliability of all the gait parameter results obtained by the smartphone (p < 0.001). All the gait parameter results obtained by the smartphone showed statistically significant and considerable correlations with the same parameter results obtained by the tri-axial accelerometer (PF r = 0.99, RMS r = 0.89, AC r = 0.85, CV r = 0.82; p < 0.01). Our study indicates that the smartphone with gait analysis application used in this study has the capacity to quantify gait parameters with a degree of accuracy that is comparable to that of the tri-axial accelerometer.

Ojiambo, R., Konstabel, K., Veidebaum, T., Reilly, J., Verbestel, V., Huybrechts, I. et al. (2012). Validity of uni-axial versus tri-axial accelerometers in the assessment of free-living energy expenditure in young children: The IDEFICS Validation Study. J Appl.Physiol.

One of the aims of Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) validation study is to validate field measures of physical activity (PA) and Energy expenditure (EE) in young children. This study compared the validity of uni-axial accelerometry with heart-rate (HR) monitoring vs. tri-axial accelerometry against doubly labeled water (DLW) criterion method for assessment of free-living EE in young children. 49 European children (25 female, 24 male) aged 4-10 years (mean age 7 +/- 2 years) were assessed by uni-axial ActiTrainer with HR, uni-axial 3DNX and tri-axial 3DNX accelerometry. Total energy expenditure (TEE) was estimated using DLW over a 1 week period. The longitudinal axis of both devices and tri-axial 3DNX counts per minute (CPM) were significantly (P<0.05) associated with physical activity level (PAL) (r = 0.51 ActiTrainer, r = 0.49 uni-axial-3DNX and r = 0.42 tri-axial summation operator3DNX). 86% of the variance in TEE could be predicted by a model combining body mass (Partial r(2) = 71%; P<0.05), CPM-ActiTrainer (Partial r(2) = 11%; P<0.05) and difference between HR at moderate and sedentary activities (ModHR – SedHR; Partial r(2) = 4%; P<0.05) The standard error (S.E) of TEE estimate for ActiTrainer and 3DNX models ranged from 0.44-0.74 MJ/d or approximately 7-11% of the average TEE. The S.E of activity-induced energy expenditure (AEE) model estimates ranged from 0.38-0.57 MJ/d or 24-26% of the average AEE. It is concluded that the comparative validity of hip-mounted uni-axial and tri-axial accelerometers for assessing PA and EE is similar

Oorschot, M., Lataster, T., Thewissen, V., Wichers, M., & Myin-Germeys, I. (2012). Mobile assessment in schizophrenia: A data-driven momentary approach. Schizophrenia Bulletin, 38, 405-413.

In this article, a data-driven approach was adopted to demonstrate how real-life diary techniques [ie, the experience sampling method (ESM)] could be deployed for assessment purposes in patients with psychotic disorder, delivering individualized and clinically relevant information. The data set included patients in an acute phase of psychosis and the focus was on paranoia as one of the main psychotic symptoms (30 patients with high levels of paranoia and 34 with low levels of paranoia). Based on individual cases, it was demonstrated how (1) symptom and mood patterns, (2) patterns of social interactions or activities, (3) contextual risk profiles (eg, is being among strangers, as opposed to family, associated with higher paranoia severity?), and (4) temporal dynamics between mood states and paranoia (eg, does anxiety precipitate or follow the onset of increased paranoia severity?) substantially differ within individual patients and across the high vs low paranoid patient group. Most striking, it was shown that individual findings are different from what is found on overall group levels. Some people stay anxious after a paranoid thought came to mind. For others, paranoia is followed by a state of relaxation. It is discussed how ESM, surfacing the patient’s implicit knowledge about symptom patterns, may provide an excellent starting point for person-tailored psychoeducation and for choosing the most applicable therapeutic intervention.

Pe, M. L., Raes, F., Koval, P., Brans, K., Verduyn, P., & Kuppens, P. (2012). Interference resolution moderates the impact of rumination and reappraisal on affective experiences in daily life. Cogn Emot..

Research has shown that cognitive control processes play a central role in emotion regulation. While most research has examined whether individual differences in such processes are related to the use of these strategies, a crucial next step involves examining whether such differences influence their impact on people’s feelings, especially in normal daily life. The present study examined whether impairments in cognitive control (measured using an affective interference resolution task) moderate the impact of using rumination and reappraisal on affective experiences in everyday life (assessed using experience sampling methods). Multilevel analyses revealed that difficulties removing previously relevant negative information from working memory were associated with a larger increase in negative affect following rumination, and smaller increase and decrease in positive and negative affect, respectively, following reappraisal. These findings show that impaired interference resolution for negative information aggravates the deleterious effects of rumination and curbs the benefits of reappraisal in daily life

Peterson, K. M. (2012). An ecological momentary investigation of spousal interactions and affect in couples with Chronic Low Back Pain. ProQuest Information & Learning, US.

Supportive relationships enhance mood and patient adjustment (Stanton, Revenson, & Tennen, 2007). However, unsupportive or critical relationships lead to relapse and poor outcomes in both mental and physical disorders (Wearden et al., 2000). The converse is also true. Patient adjustment, specifically patient mood, influences the amount of support or criticism given by spouses (Gotlib & Beach, 1995; Revenson, 1994). Both spouses in couples with Chronic Low Back Pain (CLBP) have higher than average rates of depression (Schwartz & Ehde, 2000) and marital discord (Leonard, Cano, & Johansen, 2006). Therefore, relational models describing how depression and unsupportive behavior develop in both spouses are necessary for understanding problems that these couples face. We examined bidirectional relationships between spousal affect and behavior in a sample of 105 married couples with one spouse experiencing CLBP. Ecological momentary assessment (EMA; Shiffman, Stone, & Hufford, 2008) with electronic diaries was used to obtain reports of patient and spouse affect as well as criticism and support for five times a day over 2 weeks. Hierarchical linear modeling was used to investigate both concurrent and lagged associations between behavior (criticism and support) and depressed affect. As hypothesized, both within- and cross-spouse associations between criticism and depressed affect were significant when both criticism and depressed affect were measured at the same time point. Contrary to expectations, only some within- and cross-spouse associations between support and depressed affect were significant at the same time point. Results from lagged models of criticism and depressed affect suggested that there are bidirectional relationships between spouse criticism and spouse depressed affect; as well, they highlighted the role of spouse depressed affect in predicting patient criticism. Lagged models of support were similar to those for criticism. These results highlight the implications of being critical and providing support as well as the role of spouse affect in generating marital conflict. Results also call for the importance of expanding theory and interventions to address not only patient affect but also spouse depressed affect as it may be a stress generating vehicle leading to both spouse and patient criticism and support.

Peterson, M. S., Lawman, H. G., Wilson, D. K., Fairchild, A., & Van Horn, M. L. (2012). The Association of Self-Efficacy and Parent Social Support on Physical Activity in Male and Female Adolescents. Health Psychol..

Objective: Previous research has shown that cognitive factors may account for the relationship between interpersonal factors and health behaviors. Given these findings, the current study sought to further explore the direct and indirect relationship between parental social support and adolescent physical activity (PA). Method: Data were collected from 1,421 sixth graders (73% Black, 54% females, 71% on free or reduced lunch) in South Carolina. Measures for emotional social support, instrumental social support, and adolescent self-efficacy (SE) were assessed and PA was assessed via accelerometry. Results: Parent instrumental social support was directly related to girls’ PA and parent emotional social support was inversely related to girls’ PA. Parent instrumental social support was indirectly related to boys’ PA through boys’ SE. The covaried association of SE with PA was significant for boys and marginal for girls. Conclusions: SE for overcoming barriers may be an important construct for understanding the relationship between parent instrumental social support and boys’ PA in underserved populations. The mechanisms for engaging in PA may be different for adolescent girls and boys.

Phd, S. K., Flowers, S. R., Strotman, D., Sil, S., Ting, T. V., & Schikler, K. N. (2012). Physical activity monitoring in adolescents with juvenile fibromyalgia: Findings from a clinical trial of cognitive behavioral therapy. Arthritis Care Res (Hoboken.).

Juvenile fibromyalgia (JFM) is a chronic musculoskeletal pain condition that is associated with reduced physical function. Recent research has demonstrated that cognitive-behavioral therapy (CBT) is effective in improving daily functioning among adolescents with JFM. However, it is not known whether these improvements were accompanied by increased physical activity levels. Objectives: To analyze secondary data from a randomized clinical trial of CBT to examine if CBT was associated with improvement in objectively measured physical activity and whether actigraphy indices corresponded with self-reported functioning among adolescents with JFM. Methods: Participants were 114 adolescents (ages 11-18) recruited from pediatric rheumatology clinics that met criteria for JFM and were enrolled in a clinical trial. Subjects were randomly (1:1) assigned to receive either CBT or fibromyalgia education (FE). Participants wore a hip-mounted accelerometer for one week as part of their baseline and post-treatment assessments. Results: The final sample included 68 subjects (94% female; mean age = 15.2 years) for whom complete actigraphy data was obtained. Actigraphy measures were not found to correspond with self-reported improvements in functioning. While self-reported functioning improved in the CBT condition compared to FE, no significant changes were seen in either group for activity counts, sedentary, moderate or vigorous activity. The CBT group had significantly lower peak and light activity at post-treatment. Conclusions: Actigraphy monitoring provides a unique source of information about patient outcomes. CBT intervention was not associated with increased physical activity in adolescents with JFM indicating that combining CBT with interventions to increase physical activity may enhance treatment effects. (c) 2012 by the American College of Rheumatology

Rachele, J. N., McPhail, S. M., Washington, T. L., & Cuddihy, T. F. (2012). Practical physical activity measurement in youth: a review of contemporary approaches. World J Pediatr., 8, 207-216.

BACKGROUND: The accurate evaluation of physical activity levels amongst youth is critical for quantifying physical activity behaviors and evaluating the effect of physical activity interventions. The purpose of this review is to evaluate contemporary approaches to physical activity evaluation amongst youth. DATA SOURCES: The literature from a range of sources was reviewed and synthesized to provide an overview of contemporary approaches for measuring youth physical activity. RESULTS: Five broad categories are described: selfreport, instrumental movement detection, biological approaches, direct observation, and combined methods. Emerging technologies and priorities for future research are also identified. CONCLUSIONS: There will always be a trade-off between accuracy and available resources when choosing the best approach for measuring physical activity amongst youth. Unfortunately, cost and logistical challenges may prohibit the use of “gold standard” physical activity measurement approaches such as doubly labelled water. Other objective methods such as heart rate monitoring, accelerometry, pedometry, indirect calorimetry, or a combination of measures have the potential to better capture the duration and intensity of physical activity, while self-reported measures are useful for capturing the type and context of activity

Robinson, K., Kennedy, N., & Harmon, D. (2012). The flow experiences of people with chronic pain. OTJR: Occupation, Participation and Health, 32, 104-112.

This electronic momentary assessment study explored the relationship between flow and pain intensity and examined whether flow is an optimal experience for people with chronic pain. Adults with chronic pain (n = 30) were signaled randomly seven times daily during 1 week to respond to a flow questionnaire via personal digital assistant. The participants responded to 718 questionnaires from 1,447 beeps (response rate = 49.6%). Results indicated that participants were most commonly at home, doing self-care activities, with family or alone. Participants experienced flow 34.9%, apathy 44.6%, relaxation 11.6%, and anxiety 8.9% of the sampled time. Participants’ mean concentration, self-esteem, motivation, and potency scores were highest in flow compared to the other three states. Separate one-way between-groups analyses of variance comparing concentration (F(3) = 11.85; p < .001), self-esteem (F(3) = 11.98; p < .001), motivation (F(3) = 29.29; p < .001), positive affect (F(3) = 2.89; p = .035), potency (F(3) = 19.88; p < .001), and pain intensity (F(3) = 1.39; p = .245) scores across the four states showed a significant overall effect on all comparisons except pain intensity and positive affect.

Robinson, M. D., Moeller, S. K., Buchholz, M. M., Boyd, R. L., & Troop-Gordon, W. (2012). The regulatory benefits of high levels of affect perception accuracy: A process analysis of reactions to stressors in daily life. Emotion, 12, 785-795.

Individuals attuned to affective signals from the environment may possess an advantage in the emotion-regulation realm. In two studies (total n = 151), individual differences in affective perception accuracy were assessed in an objective, performance-based manner. Subsequently, the same individuals completed daily diary protocols in which daily stressor levels were reported as well as problematic states shown to be stress-reactive in previous studies. In both studies, individual differences in affect perception accuracy interacted with daily stressor levels to predict the problematic outcomes. Daily stressors precipitated problematic reactionsGÇöwhether depressive feelings (Study 1) or somatic symptoms (Study 2)GÇöat low levels of affect perception accuracy, but did not do so at high levels of affect perception accuracy. The findings support a regulatory view of such perceptual abilities. Implications for understanding emotion regulation processes, emotional intelligence, and individual differences in reactivity are discussed.

Rose, M., Bjorner, J. B., Fischer, F., Anatchkova, M., Gandek, B., Klapp, B. F. et al. (2012). Computerized adaptive testing-Ready for ambulatory monitoring? Psychosomatic Medicine, 74, 338-348.

Background: Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted. Methods: We reviewed the literature and evaluated existing data to discuss the potential of CATs for use in ambulatory monitoring outside clinical facilities. Results: Computerized adaptive tests are not being used for ambulatory monitoring, but initial results from their use in health care research allow for discussion of some issues relevant to ambulatory care. Evidence shows that CATs can capture the most relevant health outcomes as well as established static tools, with substantially decreased respondent burden. They can be more precise than static tools of similar length and can reduce floor and ceiling effects. Computerized adaptive tests can reliably measure a construct over time with different items, which yields the potential of introducing item exposure control in ambulatory monitoring. Studies have shown that CATs can be at least as valid as well-designed static tools in group comparisons, but further investigation is needed to determine whether psychometric advantages lead to increased responsiveness of CATs. Conclusions: Ambulatory monitoring of PROs demands short, yet very precise measurements, which can be repeated up to many times a day. Computerized adaptive tests may address several present shortcomings in ambulatory monitoring of PROs efficiently. However, most CAT developments have primarily focused on psychometric improvements. To use the full potential of CATs for ambulatory monitoring purposes, content must also be carefully considered.

Rump, K. M. (2012). Affective experiences in adolescents with autism: An EMA study. ProQuest Information & Learning, US.

Clinical consensus and a limited number of empirical studies indicate that the understanding, awareness, and expression of personal emotional experiences are atypical in individuals with autism; however, the exact nature and magnitude of the atypicality is unclear. The purpose of the current study was to gain a better understanding of how individuals with autism understand and describe their own emotional experiences. This study measured affective awareness and understanding in both the laboratory setting, and in the individual’s natural environment using ecological momentary assessment. Nineteen individuals with autism (11-17 years old) and 19 typically developing controls, matched on age and IQ, completed an in-lab task asking them to describe causes of their emotions in addition to self-report measures of depression, anxiety, social skills, and alexithymia. Their parents completed corresponding parent-report forms. Following the lab visit, participants were contacted via cell phone for 14 consecutive days and were asked to rate a subset of emotions from the PANAS-C. Corresponding parent reports were collected for a random subset of these days. Results indicated that on the lab-based measure, the individuals with autism, in contrast to controls, had significantly more difficulty describing appropriate causal contexts for their self-conscious emotions. When reporting on their daily levels of affect, the individuals with autism, in contrast to controls, reported higher intensity negative affect and more lability in positive and negative affect. In comparison to parent report, there was some suggestion that the individuals with autism, but not controls, were underreporting the intensity of their negative affect. For both groups, intensity and lability of negative affect were related to self-reported depression symptoms, but not to parent reports of child depression or self- or parent-reported anxiety symptoms. In addition, no measures of affective awareness and understanding were related to child or parent reported social skills. The current findings suggest that in adolescence, the manner in which individuals with autism understand, experience, and report on their emotional experiences differs from their typically developing peers in subtle yet notable ways. Potential mechanisms underlying these differences are discussed, and a number of future directions are suggested.

Salamon, R., Johnson, E. I., & Swendsen, J. (2011). Daily life mechanisms of stress spillover among early adolescents experiencing academic difficulty. European Journal of Psychology of Education, 26, 453-463.

Research has suggested that academic stress may GÇ£spilloverGÇØ into other life domains and have negative psychological or social consequences for children and adolescents outside of school settings, but relatively few investigations have examined mediators and moderators of spillover. The current study explored the mediating role of state affect and the moderating roles of prior academic performance and mood disturbances on spillover in a sample of 131 French adolescents. Participants completed clinical measures of anxiety and depression and participated in a 7-day ambulatory monitoring phase that involved multiple daily assessments of mood, behaviors, and activities. Spillover was observed for family events and subsequent school-related events, as well as between family and leisure events. These associations remained significant when controlling for immediate mood responses, suggesting that state affect does not play a salient mediating role. There was no evidence that spillover was moderated by academic difficulty, anxiety, depression, or gender. Results are discussed in terms of the role that emotional processes may play in spillover phenomena as well as the reciprocal influence that academic and non-academic events may exert each other.

Sano, W., Nakamura, T., Yoshiuchi, K., Kitajima, T., Tsuchiya, A., Esaki, Y. et al. (2012). Enhanced persistency of resting and active periods of locomotor activity in schizophrenia. PLoS One, 7, e43539.

Patients with schizophrenia frequently exhibit behavioral abnormalities associated with its pathological symptoms. Therefore, a quantitative evaluation of behavioral dynamics could contribute to objective diagnoses of schizophrenia. However, such an approach has not been fully established because of the absence of quantitative biobehavioral measures. Recently, we studied the dynamical properties of locomotor activity, specifically how resting and active periods are interwoven in daily life. We discovered universal statistical laws (“behavioral organization”) and their alterations in patients with major depressive disorder. In this study, we evaluated behavioral organization of schizophrenic patients (n = 19) and healthy subjects (n = 11) using locomotor activity data, acquired by actigraphy, to investigate whether the laws could provide objective and quantitative measures for a possible diagnosis and assessment of symptoms. Specifically, we evaluated the cumulative distributions of resting and active periods, defined as the periods with physical activity counts successively below and above a predefined threshold, respectively. Here we report alterations in the laws governing resting and active periods; resting periods obeyed a power-law cumulative distribution with significantly lower parameter values (power-law scaling exponents), whereas active periods followed a stretched exponential distribution with significantly lower parameter values (stretching exponents), in patients. Our findings indicate enhanced persistency of both lower and higher locomotor activity periods in patients with schizophrenia, probably reflecting schizophrenic pathophysiology

Santangelo, P., Bohus, M., & Ebner-Priemer, U. W. (2012). Ecological Momentary Assessment in Borderline Personality Disorder: A Review of Recent Findings and Methodological Challenges. J Pers.Disord..

The use of Ecological Momentary Assessment (EMA) has led to increased insight into borderline personality disorder (BPD) symptoms, especially regarding affective instability. EMA is characterized by a series of repeated assessments of current affective, behavioral, and contextual experiences or physiological processes while participants engage in normal daily activities. EMA has several advantages. It enables researchers to avoid biased recollection, to investigate within-person processes, and to enhance real-life generalizability. This review is dedicated to four main objectives: (1) to discuss the characteristics of EMA in studying BPD symptomatology; (2) to provide an extensive overview of EMA findings in BPD structured into findings regarding DSM-IV criteria and findings regarding emotional dysregulation as stated in the biosocial theory of Linehan; (3) to discuss challenges of EMA and to give recommendations for the proper use of it; and (4) to highlight prospects and promising applications that should be addressed

Schafer, A. & Vagedes, J. (2012). How accurate is pulse rate variability as an estimate of heart rate variability?: A review on studies comparing photoplethysmographic technology with an electrocardiogram. Int.J Cardiol..

BACKGROUND: The usefulness of heart rate variability (HRV) as a clinical research and diagnostic tool has been verified in numerous studies. The gold standard technique comprises analyzing time series of RR intervals from an electrocardiographic signal. However, some authors have used pulse cycle intervals instead of RR intervals, as they can be determined from a pulse wave (e.g. a photoplethysmographic) signal. This option is often called pulse rate variability (PRV), and utilizing it could expand the serviceability of pulse oximeters or simplify ambulatory monitoring of HRV. METHODS: We review studies investigating the accuracy of PRV as an estimate of HRV, regardless of the underlying technology (photoplethysmography, continuous blood pressure monitoring or Finapresi, impedance plethysmography). RESULTS/CONCLUSIONS: Results speak in favor of sufficient accuracy when subjects are at rest, although many studies suggest that short-term variability is somewhat overestimated by PRV, which reflects coupling effects between respiration and the cardiovascular system. Physical activity and some mental stressors seem to impair the agreement of PRV and HRV, often to an inacceptable extent. Findings regarding the position of the sensor or the detection algorithm are not conclusive. Generally, quantitative conclusions are impeded by the fact that results of different studies are mostly incommensurable due to diverse experimental settings and/or methods of analysis

Selby, E. A., Doyle, P., Crosby, R. D., Wonderlich, S. A., Engel, S. G., Mitchell, J. D. et al. (2012). Momentary emotion surrounding bulimic behaviors in women with bulimia nervosa and borderline personality disorder. J Psychiatr.Res, 46, 1492-1500.

BACKGROUND: Bulimia nervosa (BN) and borderline personality disorder (BPD) are disorders that involve emotion dysregulation, for negative emotion in particular, as well as impulsive behaviors beyond binge eating and vomiting. Given these similarities in psychopathology, it is not surprising that those with BN also present with BPD in approximately one third of cases. Improved understanding of similarities and differences in the experience of negative and positive emotion could aid in the development of treatments specifically tailored to the needs of these disorders. METHODS: In this study, we examined Ecological Momentary Assessment (EMA) data from 133 women diagnosed with BN, 25 of whom also exhibited diagnostic levels of BPD. Emotions and behaviors were assessed daily, with multiple random and event-contingent signals to complete questionnaires on portable digital devices, for a period of two weeks. RESULTS: Results indicated that the BPD group experienced higher negative emotional variability on bulimic event days. Both groups also demonstrated increasing negative emotion and decreasing positive emotion pre- binge eating and vomiting, with levels of negative emotion decreasing and positive emotion increasing after, for both behaviors. CONCLUSIONS: In terms of group differences, additive effects were found for the BN comorbid with BPD group, who demonstrated greater negative emotional variability, on bulimic event days, and also had higher overall levels of negative emotion pre- and post-binge eating. Those with BN only, however, displayed increasing trajectories of positive emotion before and after binge eating and after vomiting, indicating a potential emotional dampening effect of BPD

Singh, B., Russell, S. D., & Cheng, A. (2012). Update on device technologies for monitoring heart failure. Curr.Treat.Options.Cardiovasc.Med., 14, 536-549.

OPINION STATEMENT: Congestive heart failure (CHF) affects more than 5 million people in the United States and is one of the most common reasons for recurrent hospitalizations. Since the majority of admissions related to CHF are secondary to progressively worsening congestion, many clinicians are quick to initiate aggressive diuresis once early signs of impending heart failure develop. These signs are based in large measure on patient-reported symptoms. Unfortunately, recent trials have shown that traditional ambulatory monitoring of heart failure using patient symptoms or body weight do not reduce episodes of decompensated heart failure requiring hospitalization. This has led to great interest in developing monitoring systems that can detect impending episodes of CHF even prior to the development of symptoms. Some of the these systems utilize existing implantable cardioverter defibrillators and cardiac resynchronization therapy devices to monitor electrophysiologic parameters including the presence of ventricular arrhythmias, heart rate variability and even transthoracic impedances. Other more recent developments have focused on more invasive hemodynamic monitoring systems that can measure pressures in the right ventricle, pulmonary arteries and the left atrium. The data on the utility of such systems is limited but encouraging. While none of these systems are currently FDA approved, they have been applied in a number of clinical trials. This paper highlights the currently available monitoring systems for heart failure and reviews the evidence supporting its use

Sliwinski, M. J. (2011). Approaches to modeling intraindividual and interindividual facets of change for developmental research. In K.L.Fingerman, C. A. Berg, J. Smith, & T. C. Antonucci (Eds.), Handbook of life-span development (pp. 1-25). New York, NY US: Springer Publishing Co.

(from the chapter) The science of human development seeks to understand how individuals change on physical, cognitive, and social dimensions of functioning across the life span. Although many informative developmental studies have relied on cross-sectional comparisons among individuals of different ages, optimal designs for addressing developmental questions must involve the study of intraindividual change across time. In this chapter, I will discuss the conceptual underpinnings and methodological approaches for linking change processes that operate across different time scales. First, I will discuss important distinctions (i.e., variability vs. change, intraindividual vs. interindividual differences in change) in developmental methodology and how they map onto commonly used analytic approaches. Second, I will explore the utility of different research designs for studying both the intraindividual and interindividual facets of developmental change across different time scales (i.e., over the shortterm and long-term). Emphasis will be given to a relatively novel hybrid research design, the measurement burst. Most longitudinal designs consist of measuring behavior once every several months or years to detect long-term developmental trends. In contrast, measurement-burst designs consist of “bursts” of intensive (e.g., daily) measurements that are repeated over longer intervals (e.g., every several months). Thus, the measurement burst combines elements of intensive short-term measurement designs (e.g., microgenetic, daily diary, experience sampling) with more conventional longitudinal designs that focus on longerterm follow-up. For example, a researcher interested in developmental changes in emotion regulation might examine affective reactivity to daily stress and how characteristics such as personality and chronic stress exposure influence these changes. A measurement-burst approach to this problem could involve repeating a week-long daily diary study every few months to examine longer-term intraindividual changes in patterns of variability and covariation between affect and stress. This type of design affords researchers with the opportunity to pose and address a rich array of questions regarding processes of intraindividual variability and change that operate across very different time intervals.

Song, M. R., Lee, Y.-S., Baek, J.-D., & Miller, M. (2012). Physical activity status in adults with depression in the National Health and Nutrition Examination Survey, 2005-2006. Public Health Nursing, 29, 208-217.

Objective: To examine physical activity levels among adults with depression. Methods: Cross-sectional descriptive study with the National Health and Nutritional Examination Survey, 2005GÇô2006. Sample: Four thousand and fifty-eight men and women aged 20 years and older. Measures: Self-reported Patient Health Questionnaire [PHQ-9] for depression, accelerometer for amounts of physical activity, demographic information, and self-reported health status were weighted to represent population estimates. Bivariate analysis and multivariate logistic regression were applied to data. Results: Overall prevalence of depression was 13.9% and 5.6% in mild and moderate to severe levels, respectively. Adults in depression groups spent significantly less time in both light and moderate physical activity than nondepression groups. There were no differences in sedentary and vigorous physical activity among groups. After controlling for socio-demographic factors, those at greater risk for depression were middle-aged women with self-reported poor health status with less moderate physical activity. Conclusions: Although depressed adults were less active than nondepressed adults, their physical activity levels were close to the recommended guidelines. Public education regarding efficacy of physical activity and encouragement of appropriate activity levels could contribute to prevention and treatment of depression.

Song, X. & Wang, X. (2012). Mind wandering in chinese daily lives – an experience sampling study. PLoS One, 7, e44423.

MIND WANDERING HAS RECENTLY RECEIVED EXTENSIVE RESEARCH BECAUSE IT REVEALS AN IMPORTANT CHARACTERISTIC OF OUR CONSCIOUSNESS: conscious experience can arise internally and involuntarily. As the first attempt to examine mind wandering in a non-western population, the present study used experience-sampling method to collect the daily momentary mind wandering episodes in a Chinese sample. The results showed that mind wandering was also a ubiquitous experience among the Chinese population, and, instead of emerging out of nowhere, it was often elicited by external or internal cues. Furthermore, most of the mind wandering episodes involved prospective thinking and were closely related to one’s personal life. Finally, the frequency of mind wandering was influenced by some contextual factors. These results taken together suggest that mind wandering plays an important role in helping people to maintain a continuous feeling of “self” and to prepare them to cope with the upcoming events

Sonnenberg, B., Riediger, M., Wrzus, C., & Wagner, G. G. (2012). Measuring time use in surveys – Concordance of survey and experience sampling measures. Soc.Sci.Res, 41, 1037-1052.

It is still unclear to what extent time allocation retrospectively reported in questionnaires reflects people’s actual behavior. Addressing this research gap, we analyze the congruence of time use information assessed through retrospective questionnaires and through experience sampling methodology. Participants completed standard survey questions on time allocation. In addition, a mobile-phone-based experience sampling technology obtained snapshots of, on average, 54 momentary activities in which respondents participated while pursuing their normal daily routines. Results indicate that the associations between standard survey questions and experience sampling methods are quite substantial for long-lasting and externally structured activities, such as paid work. In contrast, associations between survey and experience sampling methods are somewhat weaker for less externally structured, short-term and infrequent activities, such as errands, housework, and leisure. However, further research is required to elucidate which method (experience sampling method or survey questions) results in more reliable and valid measures for short-term and sporadic activities

Stamatakis, E., Davis, M., Stathi, A., & Hamer, M. (2012). Associations between multiple indicators of objectively-measured and self-reported sedentary behaviour and cardiometabolic risk in older adults. Preventive Medicine: An International Journal Devoted to Practice and Theory, 54, 82-87.

Objective: To examine the associations between sedentary behaviour (SB) measured objectively and by self-report and cardiometabolic risk factors. Method: Cross-sectional analyses of adults GëÑ60 years who participated in the 2008 Health Survey for England. Main exposures were self-reported leisure-time SB consisting of TV/DVD viewing, non-TV leisure-time sitting, and accelerometry-measured SB. Outcomes included body mass index (BMI), waist circumference, cholesterol ratio (total/HDL), Hb1Ac and prevalent diabetes. Results: 2765 participants (1256 men) had valid self-reported SB and outcomes/confounding variables data, of whom 649 (292 men) had accelerometer data. Total self-reported leisure-time SB showed multivariable-adjusted (including for moderate-to-vigorous physical activity) associations with BMI (beta for mean difference in BMI per 30 min/day extra SB: 0.088 kg/m-¦, 95% CI 0.047 to 0.130); waist circumference (0.234, 0.129 to 0.339 cm); cholesterol ratio (0.018, 0.005 to 0.032) and diabetes (odds ratio per 30 min/day extra SB: 1.059, 1.030 to 1.089). Similar associations were observed for TV time while non-TV self-reported SB showed associations only with diabetes (1.057, 1.017 to 1.099). Accelerometry SB was associated with waist circumference only (0.633, 0.173 to 1.093). Conclusion: In older adults SB is associated with cardiometabolic risk factors, but the associations are more consistent when is measured by self-report that includes TV viewing.

Sunner, L. E., Walls, C., Blood, E. A., Mehta, C. M., & Shrier, L. A. (2012). Feasibility and Utility of Momentary Sampling of Sex Events in Young Couples. J Sex Res.

Research on couples’ sexual behaviors is limited because most studies collect data from only one person, rely on retrospective recall, and lack ecological validity. This study explored the feasibility of using momentary sampling (MS) methods to collect sex event data from both members of heterosexual young adult couples. Over two weeks, 40 participants (20 couples) were asked to use a handheld computer to respond to random auditory signals each day and self-initiate a report as soon as possible after sex. Couples were randomized into two groups: (a) both partners reported after sex events, or (b) one partner reported after sex events during Week 1 and the other during Week 2 (randomized by gender). Descriptive statistics examined protocol compliance, partner agreement on whether an event occurred, condom use, and reason for sex, as well as partner involvement in reporting, comfort with reporting after sex, and study burden. Results indicated that couples were willing and able to adhere to the protocol. Partners agreed on condom use for nearly all sex events, but frequently reported different reasons for sex events. The use of MS methods to collect information about sex events within couples is a promising approach to the study of sexual behavior

Taub, E., Uswatte, G., Bowman, M. H., Mark, V. W., Delgado, A., Bryson, C. et al. (2012). Constraint-Induced Therapy Combined with Conventional Neurorehabilitation Techniques in Chronic Stroke Patients with Plegic Hands: A Case Series. Arch.Phys.Med.Rehabil..

OBJECTIVE: To determine in this pilot study whether the combination of CI therapy and conventional rehabilitation techniques can produce meaningful motor improvement in chronic stroke patients with initially fisted hands. In the past, limited success has been achieved using CI therapy alone for stroke patients with plegic hands. DESIGN: Case series SETTING: University hospital outpatient laboratory PARTICIPANTS: Consecutive sample of 6 patients > 1 yr post-stroke with plegic hands INTERVENTIONS: Treatment consisted of an initial period of 3 weeks (Phase A) when adaptive equipment in the home, orthotics and splints were employed to improve ability to engage in activities of daily living. This was continued in Phase B, when CI therapy along with selected neurodevelopmental treatment techniques were added. MAIN OUTCOME MEASURES: Motor Activity Log (MAL), accelerometry, Fugl-Meyer Motor Assessment (F-M) RESULTS: Patients exhibited a large improvement in spontaneous real-world use of the more-affected arm (mean lower-functioning MAL change = 1.3+/-0.4 points, P <0.001, d’ = 3.0), and a similar pattern of increase in an objective measure of real-world more-affected arm movement (mean change in ratio of more- to less-affected arm accelerometer recordings = 0.12+/-0.1 points, P = 0.016 d’ = 1.2). A large improvement in motor status was also recorded (mean F-M change = 5.3+/-3.3 points, P = 0.005, d’ = 1.6). CONCLUSIONS: The findings of this pilot study suggest that stroke patients with plegic hands can benefit from CI therapy combined with some conventional rehabilitation techniques, even long after brain injury. More research is warranted

Toet, A. & van Schaik, M. G. (2012). Effects of signals of disorder on fear of crime in real and virtual environments. Journal of Environmental Psychology, 32, 260-276.

Despite the fact that virtual environments are increasingly deployed to study the relation between urban planning, physical and social disorder, and fear of crime, their ecological validity for this type of research has not been established. This study compares the effects of similar signs of public disorder (litter, warning signs, cameras, signs of vandalism and car burglary) in an urban neighborhood and in its virtual counterpart on the subjective perception of safety and livability of the neighborhood. Participants made a walking tour through either the real or the virtual neighborhood, which was either in an orderly (baseline) state or adorned with numerous signs of public disorder. During their tour they reported the signs of disorder they noticed and the degree to which each of these affected their emotional state and feelings of personal safety. After finishing their tour they appraised the perceived safety and livability of the environment. Both in the real and in the simulated urban neighborhood, signs of disorder evoked associations with social disorder. In all conditions, neglected greenery was spontaneously reported as a sign of disorder. Disorder did not inspire concern for personal safety in reality and in the virtual environment with a realistic soundscape. However, in the absence of sound disorder compromised perceived personal safety in the virtual environment. Signs of disorder were associated with negative emotions more frequently in the virtual environment than in its real-world counterpart, particularly in the absence of sound. Also, signs of disorder degraded the perceived livability of the virtual, but not of the real neighborhood. Hence, it appears that people focus more on details in a virtual environment than in reality. We conclude that both a correction for this focusing effect and realistic soundscapes are required to make virtual environments an appropriate medium for both etiological (e.g. the effects of signs of disorder on fear of crime) and intervention (e.g. CPTED) research.

Tomkins-Lane, C. C. & Haig, A. J. (2012). A review of activity monitors as a new technology for objectifying function in lumbar spinal stenosis. J Back.Musculoskelet.Rehabil., 25, 177-185.

The purpose of this review article is to introduce the concept of activity monitoring, and to discuss the application of accelerometry in rehabilitation research and clinical practice using lumbar spinal stenosis as a model. Function is a complex concept, and changes in function have historically been challenging to measure. The International Classification of Functioning (ICF) defines two distinct components of function: capacity and performance. Capacity, the ability to perform a given task in a controlled environment can be measured through any number of existing functional measures. Performance, defined as activities performed on a day to day basis in the context of real life is challenging to measure, yet important in identifying the impact of pathology on real life. Recent advances in technology have allowed us to begin to measure performance, using activity monitors (accelerometers). Activity monitoring has the potential to change our concepts of outcomes, and as a result, expand our ideas about appropriateness of interventions in rehabilitation. Researchers and clinicians might benefit from using the new technology of activity monitors to measure the impact of intervention and to assess function. Therefore, this review will discuss the concept of activity monitoring and highlight potential uses for activity monitors in spine research and clinical care

Tomko, R. L., Brown, W. C., Tragesser, S. L., Wood, P. K., Mehl, M. R., & Trull, T. J. (2012). Social Context of Anger in Borderline Personality Disorder and Depressive Disorders: Findings from a Naturalistic Observation Study. J Pers.Disord..

Anger and affective instability are key features of borderline personality disorder (BPD). Given the dynamic nature of affect, it is ideally studied using ambulatory assessment (AA). Recently, several major studies have examined affective instability via momentary self-report, using electronic diaries, which participants can use throughout their daily routine. The present study sought to complement this research by using an unobtrusive naturalistic observation method, the Electronically Activated Recorder (EAR). The EAR, which captures interpersonal behavior by periodically recording 50-second snippets of ambient sounds, was worn by 25 participants with BPD who also met the specific affective instability (AI) criterion as well as 13 participants with a depressive disorder (who did not meet criteria for AI or BPD) for three days. Trained coders listened to the captured recordings and rated participants’ affect during each 50-second clip (i.e., in naturally varying social contexts). Results suggested that there were differences between diagnostic groups regarding the social context of anger, such that anger at a previous time interval predicted spending time alone in the subsequent time interval for the depressed group, but not for the BPD group. As an ambulatory observational method, the EAR offers an alternative to self-report and can provide insight into the naturalistic expression of emotions in BPD

Udachina, A., Varese, F., Oorschot, M., Myin-Germeys, I., & Bentall, R. P. (2012). Dynamics of self-esteem in “poor-me” and “bad-me” paranoia. J Nerv.Ment.Dis., 200, 777-783.

The dynamics of self-esteem and paranoia were examined in 41 patients with past or current paranoia and 23 controls using questionnaires and the Experience Sampling Method (a structured diary technique). For some analyses, patients were further divided into three groups: a) individuals who believed that persecution is underserved (“poor me”; PM), b) individuals who believed that persecution is justified (“bad me”; BM), and c) remitted patients. The results revealed that PM and especially BM patients had highly unstable psychological profiles. Beliefs about deservedness of persecution fluctuated over 6 days. BM beliefs were associated with low self-esteem and depression. Measured concurrently, paranoia predicted lower self-esteem in the BM patients. Prospectively, paranoia predicted lower subsequent self-esteem in BM patients but higher subsequent self-esteem in PM patients. Our results suggest that paranoia can serve a defensive function in some circumstances. The reasons for inconsistencies in self-esteem research in relation to paranoia are discussed

Van, C. E., De, B., I, Maes, L., & Cardon, G. (2012). Efficacy and feasibility of lowering playground density to promote physical activity and to discourage sedentary time during recess at preschool: A pilot study. Prev.Med..

OBJECTIVE: This pilot study examined if lowering playground density is feasible and effective in improving preschoolers’ activity and sedentary levels during recess. METHOD: Between November and December 2011, a within-subject design was used to study preschoolers’ activity via accelerometry during recesses in the usual conditions (baseline) and with lower playground density (intervention). During the intervention, preschools scheduled extra recesses so that the number of classes usually sharing the playground was halved. Effects were investigated, using two-level linear regression models, in 1

Vanhelst, J., Hurdiel, R., Mikulovic, J., Bui-Xuan, G., Fardy, P., Theunynck, D. et al. (2012). Validation of the Vivago Wrist-Worn accelerometer in the assessment of physical activity. BMC.Public Health, 12, 690.

BACKGROUND: Most accelerometers are worn around the waist (hip or lower back) to assess habitual physical activity. Wrist-worn accelerometers may be an alternative to the waist-worn monitors and may improve compliance in studies with prolonged wear. The aim of this study was to validate the Vivago[REGISTERED SIGN] Wrist-Worn Accelerometer at various intensities of physical activity (PA) in adults. METHODS: Twenty-one healthy adults aged 20–34 years were recruited for the study. Accelerometer data and oxygen uptake (VO2) were measured at sedentary, light, moderate and vigorous levels of PA. RESULTS: Activity categories and accelerometer counts were: sedentary, 0–15 counts[DOT OPERATOR]min[MINUS SIGN]1; light, 16–40 counts[DOT OPERATOR]min[MINUS SIGN]1; moderate, 41–85 counts[DOT OPERATOR]min[MINUS SIGN]1; and vigorous activity, > 85 counts[DOT OPERATOR]min[MINUS SIGN]1. ANOVA repeated measures was used to determine the relationship between accelerometry data output and oxygen consumption (r = .89; p < .001). The Bland and Altman method showed good agreement in the assessment of energy expenditure between the indirect calorimetry and the data obtained by the accelerometer. CONCLUSIONS: Results of the study suggest that the Vivago[REGISTERED SIGN] wrist-worn accelerometer is a valid measure of PA at varying levels of intensity. The study has also defined threshold values at four intensities and hence the Vivago[REGISTERED SIGN] accelerometer may be used to quantify PA in free living conditions among adults. This device has possible application in treating a variety of important health concerns

Vanhelst, J., Baquet, G., Gottrand, F., & Beghin, L. (2012). Comparative interinstrument reliability of uniaxial and triaxial accelerometers in free-living conditions. Percept.Mot.Skills, 114, 584-594.

The aim of this study was to measure the inter-instrument reliability of the ActiGraph and RT3 accelerometers in free-living conditions. 15 healthy adults wore eight ActiGraph accelerometers and five RT3 accelerometers fastened to their back with an elastic belt and adjustable buckle in free-living conditions. For both accelerometers, the inter-instrument coefficient of variation (CV) decreased with increasing physical activity intensity. The inter-instrument CV of the ActiGraph (3% to 10.5%) was significantly lower than that of the RT3 (12.6% to 35.5%; p < 0.05). This finding demonstrates that the ActiGraph has higher inter-instrument reliability than the RT3. For both accelerometers, the inter-instrument reliability was higher for moderate and vigorous physical activity, the two intensities recommended for public health purposes. Studies using these devices can be compared with a low risk of misclassification of participants who meet the recommendation to perform moderate to vigorous physical activity

Vella, E. J., Kamarck, T. W., Flory, J. D., & Manuck, S. (2012). Hostile Mood and Social Strain During Daily Life: A Test of the Transactional Model. Ann.Behav.Med..

BACKGROUND: Hostility is a multidimensional construct related to cardiovascular (CV) disease risk. Daily hostile mood and social interactions may precipitate stress-related CV responses in hostile individuals. PURPOSE: Determine whether trait cognitive hostility best predicts daily hostile mood and social interactions relative to other trait hostility factors and explore the temporal links between these daily measures. METHODS: One hundred seventy-one participants completed assessments of four trait hostility scales. Participants completed an electronic diary across 3 days, assessing current hostile mood and social interaction quality. RESULTS: Multiple regression analyses revealed both affective and cognitive hostility to be significant predictors of daily hostile mood, and cognitive hostility alone to predict daily social strain. Additional analyses revealed previous social strain to predict elevated subsequent hostile mood. CONCLUSIONS: Episodes of social strain may give rise to elevated hostile mood. Trait cognitive hostility may be an important factor in predicting daily social strain

Villars, C., Bergouignan, A., Dugas, J., Antoun, E., Schoeller, D. A., Roth, H. et al. (2012). Validity of combining heart rate and uniaxial acceleration to measure free-living physical activity energy expenditure in young men. J Appl.Physiol.

Background: Combining accelerometry (ACC) with heart rate (HR) monitoring is thought to improve activity energy expenditure (AEE) estimations compared to ACC alone. Objective: To evaluate the validity of ACC and HR used alone or combined to estimate AEE in free living conditions, compared to doubly-labeled water (DLW). Methods: Ten-day free-living AEE was measured by a DLW protocol in thirty-five 18-55 y men (11 lean active, 12 lean sedentary, 12 overweight sedentary) wearing an Actiheart (combining ACC and HR) and a RT3 accelerometer. AEE was estimated using group- or individual-calibration of the HR/AEE relationship, based on an exercise tolerance test. In a subset (n=21), AEE changes were measured after one month of detraining (active subjects) or an 8-week training (sedentary subjects). Results: Actiheart combined ACC/HR estimates were more accurate than estimates from HR or ACC alone. Accuracy of the Actiheart group-calibrated ACC/HR estimates was modest (intra-class correlation coefficient [ICC]=0.62), with no bias but high root mean square error (RMSE) and limits of agreement (LOA). The mean bias of the estimates was reduced by one third, like RMSE and LOA, by individual calibration (ICC=0.80). Contrasting with group-calibrated estimates, the Actiheart individual-calibrated ACC/HR estimates explained 38% of the variance of the DLW-AEE change (ICC=0.63). Conclusion: This study supports a good level of agreement between the Actiheart ACC/HR estimates and DLW-measured AEE in lean and overweight men with varying fitness levels. Individual calibration of the HR/AEE relationship is necessary for AEE-estimations at individual level rather than at group scale and for AEE change evaluation

Volmer, J., Binnewies, C., Sonnentag, S., & Niessen, C. (2012). Do social conflicts with customers at work encroach upon our private lives? A diary study. J Occup.Health Psychol., 17, 304-315.

Social interactions at work can strongly influence people’s well-being. Extending past research, we examined how social conflicts with customers at work (SCCs) are related to employees’ well-being (i.e., state negative affect, NA) and nonwork experiences (i.e., psychological detachment from work and negative work reflection at home) on a daily level. Using experience-sampling methodology, we collected data from 98 civil service agents over 5 working days. Hierarchical linear modeling revealed that on the daily level, SCCs were related to employees’ NA as well as with their nonwork experiences. Specifically, SCCs were negatively related to psychological detachment from work and positively related to negative work reflection after work. Furthermore, results provide support for the mediating role of NA in the SCC-nonwork experiences relationship. The findings of the present study broaden the scope of workplace conflict research by showing that conflicts are not only associated with employees’ impaired well-being but even encroach on their nonwork experiences

Walsh, M. A., Brown, L. H., Barrantes-Vidal, N., & Kwapil, T. R. (2012). The expression of affective temperaments in daily life. J Affect.Disord..

BACKGROUND: Numerous validation studies have examined the TEMPS-A in both clinical and nonclinical samples. However, the majority of these studies utilized cross-sectional assessments in laboratory or clinical settings. The present study is the first to examine the expression of affective temperaments in daily life using experience sampling methodology (ESM). METHODS: 138 participants completed the TEMPS-A and received a personalized digital assistant that signaled them eight times daily for one week to complete questionnaires that assessed affect, cognition, behavior, sense of self, and social interaction. RESULTS: As expected, cyclothymic/irritable temperament was positively associated with negative affect, risky behavior, and restlessness, and was negatively associated with positive affect and preference to be with others in daily life. In contrast, hyperthymic temperament was associated with positive affect, fullness of thought, doing many and exciting things, grandiosity, and preference to be with others in daily life. Dysthymic temperament was modestly associated with worry, and was positively associated with trouble concentrating, fullness of thought, and a preference for social contact. Cross-level interactions indicated that cyclothymic/irritable temperament was associated with elevated stress reactivity in daily life. LIMITATIONS: ESM data collection was limited to one week. Longer assessment periods might better capture the cyclical nature of affective temperaments. CONCLUSIONS: This was the first study to examine affective temperaments in daily life. The findings offer further validation of the TEMPS-A, as well as the maladaptive nature of the cyclothymic/irritable temperament

Wenze, S. J., Gunthert, K. C., & German, R. E. (2012). Biases in affective forecasting and recall in individuals with depression and anxiety symptoms. Personality and Social Psychology Bulletin, 38, 895-906.

The authors used experience sampling to investigate biases in affective forecasting and recall in individuals with varying levels of depression and anxiety symptoms. Participants who were higher in depression symptoms demonstrated stronger (more pessimistic) negative mood prediction biases, marginally stronger negative mood recall biases, and weaker (less optimistic)positive mood prediction and recall biases. Participants who were higher in anxiety symptoms demonstrated stronger negative mood prediction biases, but positive mood prediction biases that were on par with those who were lower in anxiety. Anxiety symptoms were not associated with mood recall biases. Neither depression symptoms nor anxiety symptoms were associated with bias in event prediction. Their findings fit well with the tripartite model of depression and anxiety. Results are also consistent with the conceptualization of anxiety as a GÇ£forward-lookingGÇØ disorder, and with theories that emphasize the importance of pessimism and general negative information processing in depressive functioning.

Wolfram, M., Bellingrath, S., Feuerhahn, N., & Kudielka, B. M. (2012). Cortisol Responses to Naturalistic and Laboratory Stress in Student Teachers: Comparison with a Non-stress Control Day. Stress Health.

Ambulatory assessments of hypothalamus-pituitary-adrenal axis responses to acute natural stressors yield evidence on stress regulation with high ecological validity. Sampling of salivary cortisol is a standard technique in this field. In 21 healthy student teachers, we assessed cortisol responses to a demonstration lesson. On a control day, sampling was repeated at analogous times. Additionally, the cortisol awakening response (CAR) was assessed on both days. Participants were also exposed to a laboratory stressor, the Trier Social Stress Test, and rated their individual levels of chronic work stress. In pre-to-post-stress assessment, cortisol levels declined after the lesson. However, post-stress cortisol levels were significantly higher compared with those on the control day. Also, the Trier Social Stress Test yielded higher cortisol responses when using the control day as reference baseline. Associations between the CAR and chronic stress measures were observed solely on the control day. There were no significant associations between cortisol responses to the natural and laboratory stressors. Our results indicate that a control day might be an important complement in laboratory but especially in ambulatory stress research. Furthermore, associations between chronic stress measures and the CAR might be obscured by acute stress exposure. Finally, responses to the laboratory stressor do not seem to mirror natural stress responses. Copyright (c) 2012 John Wiley & Sons, Ltd

Yeh, V. M., McCarthy, D. E., & Baker, T. B. (2012). An Ecological Momentary Assessment Analysis of Prequit Markers for Smoking-Cessation Failure. Exp.Clin.Psychopharmacol..

This study aimed to identify correlates of smoking-cessation failure, a failure to establish abstinence during a quit-smoking attempt. Identifying risk factors for early failure could facilitate the development of tailored interventions to promote cessation. The current study used existing ecological momentary assessment (EMA) data to investigate the extent to which prequit craving, negative affect, and recent smoking were associated with cessation failure in 374 smokers (189, 50.5% female). Subjects were prompted to complete 4-7 real-time reports of craving, negative affect, and recent smoking daily in the four days prior to quitting. Multilevel models of craving and negative affect (mean level, growth, volatility, and association with smoking) were estimated. Results indicated that recent smoking was associated with significantly lower craving among smokers who failed to quit than those who achieved a full day of cessation, but this held only among smokers who reduced smoking by at least 10% in the days preceding the quit attempt. Smokers who failed to quit on the quit day also experienced slower increases in negative affect in the days preceding the quit attempt than did initial abstainers, but delayed quitters and delayed cessation failures did not differ in negative-affect trajectories. These results suggest that successful abstainers and cessation failures can be differentiated by specific dimensions of prequit craving and negative-affect experiences, but the effects hold only in certain circumstances.

Zhou, J., Liu, C., Shan, P., Zhou, Y., Xu, E., & Ji, Y. (2012). Prevalence and distinguishing features of masked hypertension in type 2 diabetic patients. J Diabetes Complications.

OBJECTIVE: The prevalence and clinical features of masked hypertension (MH) in type 2 diabetes mellitus patients (T(2)DM) were investigated to define clinical indices which may aid diagnosis and treatment. METHODS: Clinical blood pressure (CBP) and ambulatory blood pressure (ABP) were measured in 856 T(2)DM patients to differentiate normotensive (NT), essential hypertensive (EH), and MH. Waist circumference (WC), abdominal circumference (AC), body mass index (BMI), waist to height ratio (WHtR), fasting blood glucose (FBG), and glycated hemoglobin levels were measured and compared between BP groups. RESULTS: In total, 359 patients had normal CBP, of which 13.37% were diagnosed with MH based on established criteria. Males had significantly higher rates of MH (15.30%) than females (11.36%) (P=0.036). The MH detection rate increased with age and T(2)DM duration. There were no significant differences in BMI, WC or WHtR between total MH and EH groups. MH females, however, had lower BMIs than female EH females (P=0.023). Smoking, alcohol, and familial EH history were lower in MH than EH patients (smoking, P=0.029; alcohol ,P=0.001; and EH history, P=0.000), while BMI (male, P=0.037, female, P=0.015), WC (male, P=0.012, female, P=0.021), WHtR (P=0.011), smoking (P=0.016), and alcohol consumption (P=0.000) were higher in MH than NT patients. BMI, WHtR, 6-15year disease course of diabetes, smoking and alcoholism were independent risk factors of T(2)DM complicated with MH. The dipper BP circadian pattern was significantly lower in MH than NT patients (P=0.001). The non-dipper pattern was lower in MH than EH (P=0.018) but higher than in NT (P=0.000). CONCLUSIONS: A significant fraction of T(2)DM patients were diagnosed with MH. Clinical presentation also contrasted sharply from EH, MH is a specific blood pressure status that may severely damage target organs in T(2)DM

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