Society for Ambulatory Assessment

Second quarter 2014 (April to June)

Aizawa, Kiyoharu; Maeda, Kazuki; Ogawa, Makoto; Sato, Yohei; Kasamatsu, Mayumi; Waki, Kayo; Takimoto, Hidemi (2014): Comparative Study of the Routine Daily Usability of FoodLog: A Smartphone-based Food Recording Tool Assisted by Image Retrieval. In: J Diabetes Sci Technol 8 (2), S. 203–208. DOI: 10.1177/1932296814522745.

The health care field is focusing considerable attention on dietary control, which requires that individuals record what they eat. We have developed a novel smartphone application called FoodLog, a multimedia food recording tool that allows users to take photos of their meals and to produce textual food records. Unlike conventional smartphone-based food recording tools, FoodLog allows users to employ meal photos to help them to input textual descriptions based on image retrieval. In this study, we conducted usability experiments to evaluate the routine daily use of FoodLog systems with and without image-based assistance. We produced 2 food recording tools: FoodLog with image-based assistance (FL-I) and FoodLog with text input only (FL-T). We recruited 18 university students (age = 18-24 years), all of whom performed food recording for the first time. The participants used FoodLog on a daily basis for 1 month. In the subjective evaluation, FL-I had higher average scores for questions related to ease of use, fun, frequency of browsing, and intention to continue. In particular, the latter 3 factors received significantly higher scores with FL-I than with FL-T. In the quantitative evaluation, the daily average number of meal events and food records did not differ significantly between FL-I and FL-T. A detailed analysis of the individual records showed that 1 participant produced 3 times as many records using FL-I compared with FL-T. The subjective assessment showed that our new tool, which fully exploits the use of images, is a promising method for food recording.

Ayabe, Makoto; Kumahara, Hideaki; Morimura, Kazuhiro; Tanaka, Hiroaki (2014): Interruption in physical activity bout analysis: an accelerometry research issue. In: BMC Res Notes 7, S. 284. DOI: 10.1186/1756-0500-7-284.

BACKGROUND: The purpose of the present investigation was to clarify the impact of the treatment of interruptions on the durations and the frequency of the physical activity (PA) bouts under free-living conditions. METHODS: One hundred and forty adults (50 +/- 7 years) wore an accelerometer (Lifecorder) for seven consecutive days under free-living conditions. According to the minutes by minutes metabolic equivalents (METs) value, the PA was divided into one of three intensity categories: light intensity PA (LPA, < 3 METs), moderate intensity PA (MPA, 3 to 6 METs), vigorous intensity PA (VPA, > 6 METs), and the sum of the MPA and VPA was defined as moderate to vigorous intensity PA (MVPA, > 3 METs). Thereafter, based on the time series data, we defined MVPA bouts as PA that was maintained at no less than 3 METs completely for 10 minutes or longer with or without allowing for a one-minute or a two-minute break (<3METs). RESULTS: The frequency and duration of the continuous MVPA bouts lasting longer than 10-min were significantly lower and shorter compared with that in the non-continuous MVPA bouts allowing a one- or two-minute interruption (4.11 +/- 1.65, 6.58 +/- 2.72 and 8.97 +/- 3.55 bouts/day, 71.62 +/- 33.66, 119.03 +/- 49.35 and 169.75 +/- 65.87 min/day, P < 0.05). The number of days with a total time of MVPA bouts of 30-min was significantly lower in the continuous MVPA bouts compared with that in the non-continuous MVPA bouts allowing a 1-min or 2-min interruption (5.36 +/- 1.65, 6.39 +/- 1.07 and 6.65 +/- 0.85 days/week). CONCLUSION: The treatment of interruptions for the setting of the accelerometer affects the estimation of the MVPA bouts under free-living conditions in middle-aged to older adults. The best analysis process with regard to the accelerometer quantifying the break to reflect the real behavioral pattern and the physiological stress in such subjects remains unclear.

Baird, Benjamin; Smallwood, Jonathan; Lutz, Antoine; Schooler, Jonathan W. (2014): The Decoupled Mind: Mind-wandering Disrupts Cortical Phase-locking to Perceptual Events. In: J Cogn Neurosci. DOI: 10.1162/jocn_a_00656.

The mind flows in a “stream of consciousness,” which often neglects immediate sensory input in favor of focusing on intrinsic, self-generated thoughts or images. Although considerable research has documented the disruptive influences of task-unrelated thought for perceptual processing and task performance, the brain dynamics associated with these phenomena are not well understood. Here we investigate the possibility, suggested by several convergent lines of research, that task-unrelated thought is associated with a reduction in the trial-to-trial phase consistency of the oscillatory neural signal in response to perceptual input. Using an experience sampling paradigm coupled with continuous high-density electroencephalography, we observed that task-unrelated thought was associated with a reduction of the P1 ERP, replicating prior observations that mind-wandering is accompanied by a reduction of the brain-evoked response to sensory input. Time-frequency analysis of the oscillatory neural response revealed a decrease in theta-band cortical phase-locking, which peaked over parietal scalp regions. Furthermore, we observed that task-unrelated thought impacted the oscillatory mode of the brain during the initiation of a task-relevant action, such that more cortical processing was required to meet task demands. Together, these findings document that the attenuation of perceptual processing that occurs during task-unrelated thought is associated with a reduction in the temporal fidelity with which the brain responds to a stimulus and suggest that increased neural processing may be required to recouple attention to a task. More generally, these data provide novel confirmatory evidence for the mechanisms through which attentional states facilitate the neural processing of sensory input.

Bakker, J. M.; Lieverse, R.; Menne-Lothmann, C.; Viechtbauer, W.; Pishva, E.; Kenis, G. et al. (2014): Therapygenetics in mindfulness-based cognitive therapy: do genes have an impact on therapy-induced change in real-life positive affective experiences? In: Transl Psychiatry 4, S. e384. DOI: 10.1038/tp.2014.23.

Positive affect (PA) has an important role in resilience against depression and has been shown to increase with mindfulness-based cognitive therapy (MBCT). To elucidate the underlying mechanisms of change in PA as well as develop insights that may benefit personalized medicine, the current study examined the contribution of genetic variation to individual differences in change in PA in response to MBCT. Individuals (n=126) with residual depressive symptoms were randomized to either an MBCT group or treatment as usual. PA was assessed using experience sampling methodology (ESM). Single-nucleotide polymorphisms (SNPs) in genes known to be involved in reward functioning were selected. SNPs in the genes for brain-derived neurotrophic factor (BDNF), the muscarinic acetylcholine receptor M2 (CHRM2), the dopamine receptor D4 (DRD4) and the mu1 opioid receptor (OPRM1) significantly moderated the impact of treatment condition over time on PA. Genetic variation in the genes for CHRM2 and OPRM1 specifically had an impact on the level of PA following MBCT. The current study shows that variation in response to MBCT may be contingent on genetic factors associated with the regulation of PA. These findings contribute to our understanding of the processes moderating response to treatment and prediction of treatment outcome.

Baxter, Suzanne D.; Hitchcock, David B.; Guinn, Caroline H.; Vaadi, Kate K.; Puryear, Megan P.; Royer, Julie A. et al. (2014): A Validation Study Concerning the Effects of Interview Content, Retention Interval, and Grade on Children’s Recall Accuracy for Dietary Intake and/or Physical Activity. In: J Acad Nutr Diet. DOI: 10.1016/j.jand.2014.02.017.

BACKGROUND: Practitioners and researchers are interested in assessing children’s dietary intake and physical activity together to maximize resources and minimize subject burden. OBJECTIVE: Our aim was to investigate differences in dietary and/or physical activity recall accuracy by content (diet only; physical activity only; diet and physical activity), retention interval (same-day recalls in the afternoon; previous-day recalls in the morning), and grade (third; fifth). DESIGN: Children (n=144; 66% African American, 13% white, 12% Hispanic, 9% other; 50% girls) from four schools were randomly selected for interviews about one of three contents. Each content group was equally divided by retention interval, each equally divided by grade, each equally divided by sex. Information concerning diet and physical activity at school was validated with school-provided breakfast and lunch observations, and accelerometry, respectively. Dietary accuracy measures were food-item omission and intrusion rates, and kilocalorie correspondence rate and inflation ratio. Physical activity accuracy measures were absolute and arithmetic differences for moderate to vigorous physical activity minutes. STATISTICAL ANALYSES PERFORMED: For each accuracy measure, linear models determined effects of content, retention interval, grade, and their two-way and three-way interactions; ethnicity and sex were control variables. RESULTS: Content was significant within four interactions: intrusion rate (contentxretention-intervalxgrade; P=0.0004), correspondence rate (contentxgrade; P=0.0004), inflation ratio (contentxgrade; P=0.0104), and arithmetic difference (contentxretention-intervalxgrade; P=0.0070). Retention interval was significant for correspondence rate (P=0.0004), inflation ratio (P=0.0014), and three interactions: omission rate (retention-intervalxgrade; P=0.0095), intrusion rate, and arithmetic difference (both already mentioned). Grade was significant for absolute difference (P=0.0233) and five interactions mentioned. Content effects depended on other factors. Grade effects were mixed. Dietary accuracy was better with same-day than previous-day retention interval. CONCLUSIONS: Results do not support integrating dietary intake and physical activity in children’s recalls, but do support using shorter rather than longer retention intervals to yield more accurate dietary recalls. Additional validation studies need to clarify age effects and identify evidence-based practices to improve children’s accuracy for recalling dietary intake and/or physical activity.

Berkman, Elliot T.; Giuliani, Nicole R.; Pruitt, Alicia K. (2014): Comparison of text messaging and paper-and-pencil for ecological momentary assessment of food craving and intake. In: Appetite. DOI: 10.1016/j.appet.2014.06.010.

Electronic devices such as mobile phones are quickly becoming a popular way to gather participant reports of everyday thoughts, feelings, and behaviors, including food cravings and intake. Electronic devices offer a number of advantages over alternative methods such as paper-and-pencil (PNP) assessment including automated prompts, on-the-fly data transmission, and participant familiarity with and ownership of the devices. However, only a handful of studies have systematically compared compliance between electronic and PNP methods of ecological momentary assessment (EMA), and none have examined eating specifically. Existing comparisons generally find greater compliance for electronic devices than PNP, but there is variability in the results across studies that may be accounted for by differences across research domains. Here, we compared the two EMA methods in an unexamined domain - eating - in terms of response rate and response latency, and their sensitivity to individual difference variables such as body mass index (BMI). Forty-four participants were randomly assigned to report on their food craving, food intake, and hunger four times each day for 2 weeks using either a PNP diary (N = 19) or text messaging (TXT; N = 25). Response rates were higher for TXT than PNP (96% vs. 70%) and latencies were faster (29 min vs. 79 min), and response rate and latency were less influenced by BMI in the TXT condition than in the PNP condition. These results support the feasibility of using text messaging for EMA in the eating domain, and more broadly highlight the ways that research domain-specific considerations (e.g., the importance of response latency in measuring short-lived food craving) interact with assessment modality during EMA.

Bond, Dale S.; Thomas, J. Graham; Raynor, Hollie A.; Moon, Jon; Sieling, Jared; Trautvetter, Jennifer et al. (2014): B-MOBILE - A Smartphone-Based Intervention to Reduce Sedentary Time in Overweight/Obese Individuals: A Within-Subjects Experimental Trial. In: PLoS One 9 (6), S. e100821. DOI: 10.1371/journal.pone.0100821.

PURPOSE: Excessive sedentary time (SED) has been linked to obesity and other adverse health outcomes. However, few sedentary-reducing interventions exist and none have utilized smartphones to automate behavioral strategies to decrease SED. We tested a smartphone-based intervention to monitor and decrease SED in overweight/obese individuals, and compared 3 approaches to prompting physical activity (PA) breaks and delivering feedback on SED. DESIGN AND METHODS: Participants [N = 30; Age = 47.5(13.5) years; 83% female; Body Mass Index (BMI) = 36.2(7.5) kg/m2] wore the SenseWear Mini Armband (SWA) to objectively measure SED for 7 days at baseline. Participants were then presented with 3 smartphone-based PA break conditions in counterbalanced order: (1) 3-min break after 30 SED min; (2) 6-min break after 60 SED min; and (3) 12-min break after 120 SED min. Participants followed each condition for 7 days and wore the SWA throughout. RESULTS: All PA break conditions yielded significant decreases in SED and increases in light (LPA) and moderate-to-vigorous PA (MVPA) (p<0.005). Average % SED at baseline (72.2%) decreased by 5.9%, 5.6%, and 3.3% [i.e. by mean (95% CI) -47.2(-66.3, -28.2), -44.5(-65.2, -23.8), and -26.2(-40.7, -11.6) min/d] in the 3-, 6-, and 12-min conditions, respectively. Conversely, % LPA increased from 22.8% to 26.7%, 26.7%, and 24.7% [i.e. by 31.0(15.8, 46.2), 31.0(13.6, 48.4), and 15.3(3.9, 26.8) min/d], and % MVPA increased from 5.0% to 7.0%, 6.7%, and 6.3% (i.e. by 16.2(8.5, 24.0), 13.5(6.3, 20.6), and 10.8(4.2, 17.5) min/d] in the 3-, 6-, and 12-min conditions, respectively. Planned pairwise comparisons revealed the 3-min condition was superior to the 12-min condition in decreasing SED and increasing LPA (p<0.05). CONCLUSION: The smartphone-based intervention significantly reduced SED. Prompting frequent short activity breaks may be the most effective way to decrease SED and increase PA in overweight/obese individuals. Future investigations should determine whether these SED reductions can be maintained long-term. TRIAL REGISTRATION: NCT01688804.

Brodbeck, Jeannette; Bachmann, Monica S.; Brown, Anna; Znoj, Hans Joerg (2014): Effects of depressive symptoms on antecedents of lapses during a smoking cessation attempt: An ecological momentary assessment study. In: Addiction. Online verfügbar unter

Abstract Aims To investigate pathways through which momentary negative affect and depressive symptoms affect risk of lapse during smoking cessation attempts. Design Ecological momentary assessment was carried out during 2 weeks after an unassisted smoking cessation attempt. A 3‐month follow‐up measured smoking frequency. Setting Data were collected via mobile devices in German‐speaking Switzerland. Participants A total of 242 individuals (age 20–40, 67% men) reported 7112 observations. Measurements Online surveys assessed baseline depressive symptoms and nicotine dependence. Real‐time data on negative affect, physical withdrawal symptoms, urge to smoke, abstinence‐related self‐efficacy and lapses. Findings A two‐level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self‐efficacy (β = 0.20; β = −0.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (β = 0.09) and lower self‐efficacy (β = −0.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person’s average negative affect (β = 0.35, all P < 0.001). However, the baseline characteristics influenced smoking frequency 3 months later only indirectly, through influences of average states on the number of lapses during the quit attempt. Conclusions Controlling for nicotine dependence, higher depressive symptoms at baseline were associated strongly with a worse longer‐term outcome. Negative affect experienced during the quit attempt was the only pathway through which the baseline depressive symptoms were associated with a reduced self‐efficacy and increased urges to smoke, all leading to the increased probability of lapses.

Brown, Barbara B.; Wilson, Laura; Tribby, Calvin P.; Werner, Carol M.; Wolf, Jean; Miller, Harvey J.; Smith, Ken R. (2014): Adding maps (GPS) to accelerometry data to improve study participants’ recall of physical activity: a methodological advance in physical activity research. In: Br J Sports Med 48 (13), S. 1054–1058. DOI: 10.1136/bjsports-2014-093530.

OBJECTIVE: Obtaining the ‘when, where and why’ of healthy bouts of moderate-to-vigorous physical activity (MVPA) provides insights into natural PA. DESIGN: In Salt Lake City, Utah, adults wore accelerometer and Global Positioning System (GPS) loggers for a week in a cross-sectional study to establish baseline travel and activity patterns near a planned Complete Street intervention involving a new rail line, new sidewalks and a bike path. RESULTS: At the end of the week, research assistants met with the 918 participants who had at least three 10 h days of good accelerometer readings. Accelerometer and GPS data were uploaded and integrated within a custom application, and participants were provided with maps and time information for past MVPA bouts of >/=3 min to help them recall bout details. Participants said that ‘getting someplace’ was, on average, a more important motivation for their bouts than leisure or exercise. A series of recall tests showed that participants recalled most bouts they were asked about, regardless of the duration of the bout, suggesting that participant perceptions of their shorter lifestyle bouts can be studied with this methodology. Visual prompting with a map depicting where each bout took place yielded more accurate recall than prompting with time cues alone. CONCLUSIONS: These techniques provide a novel way to understand participant memories of the context and subjective assessments associated with healthy bouts of PA. Prompts with time-stamped maps that illustrate places of MVPA offer an effective method to improve understanding of activity and its supportive sociophysical contexts.

Burgess, Helen J.; Molina, Thomas A. (2014): Home lighting before usual bedtime impacts circadian timing: a field study. In: Photochem Photobiol 90 (3), S. 723–726.

Laboratory studies suggest that evening light before bedtime can suppress melatonin. Here, we measured the range of evening light intensity people can generate with their household lights, and for the first time determined if varying home light before usual bedtime can shift circadian phase. This was a 3-week study with two counterbalanced conditions separated by a 5-day break. In a dim week, eight healthy subjects minimized their home light exposure from 4 h before habitual bedtime until a self-selected bedtime. In a bright week, the subjects maximized their home lighting for the same time. The dim light melatonin onset (DLMO) was assessed after each week. On average subjects maximized their lights to approximately 65 lux and minimized their lights to approximately 3 lux. Wrist actigraphy indicated that subjects went to bed slightly later when lights were maximized (average 14 min later, P = 0.05), but wake time did not change. Every subject had a later DLMO after the week of maximum versus minimum light exposure (average 1:03 h later, P < 0.001). These results demonstrate that the light intensity people can generate at home in the few hours before habitual bedtime can alter circadian timing. People should reduce their evening light exposure to lessen circadian misalignment.

Bush, Nigel E.; Dobscha, Steven K.; Crumpton, Rosa; Denneson, Lauren M.; Hoffman, Julia E.; Crain, Aysha et al. (2014): A Virtual Hope Box Smartphone App as an Accessory to Therapy: Proof-of-Concept in a Clinical Sample of Veterans. In: Suicide Life Threat Behav. DOI: 10.1111/sltb.12103.

A “Hope Box” is a therapeutic tool employed by clinicians with patients who are having difficulty coping with negative thoughts and stress, including patients who may be at risk of suicide or nonsuicidal self-harm. We conducted a proof-of-concept test of a “Virtual” Hope Box (VHB)-a smartphone app that delivers patient-tailored coping tools. Compared with a conventional hope box integrated into VA behavioral health treatment, high-risk patients and their clinicians used the VHB more regularly and found the VHB beneficial, useful, easy to set up, and said they were likely to use the VHB in the future and recommend the VHB to peers.

Businelle, Michael S.; Ma, Ping; Kendzor, Darla E.; Reitzel, Lorraine R.; Chen, Minxing; Lam, Cho Y. et al. (2014): Predicting Quit Attempts Among Homeless Smokers Seeking Cessation Treatment: An Ecological Momentary Assessment Study. In: Nicotine Tob Res. DOI: 10.1093/ntr/ntu088.

INTRODUCTION: Homeless adults are more likely to smoke tobacco and less likely to successfully quit smoking than smokers in the general population, despite comparable numbers of cessation attempts and desire to quit. To date, studies that have examined smoking cessation in homeless samples have used traditional lab/clinic-based assessment methodologies. Real-time assessment of key variables may provide new insights into the process of quitting among homeless smokers. METHODS: The purpose of the current study was to identify predictors of a quit attempt using real-time assessment methodology during the 6 days prior to a scheduled quit attempt in homeless adults seeking care at a shelter-based smoking cessation clinic. Parameters for multiple variables (i.e., motivation for quitting, smoking expectancies, quit self-efficacy, smoking urges, negative affect, positive affect, restlessness, hostility, and stress) were calculated and used as predictors of biochemically verified quit date abstinence (i.e., >/=13hr abstinent) using logistic regression analyses. RESULTS: Participants (n = 57) were predominantly male (59.6%), non-White (68.4%), and smoked an average of 18 cigarettes per day. A total of 1,132 ecological momentary assessments (83% completion rate) were collected at random times (i.e., up to 4 assessments/day) during the 6 days prior to a scheduled quit attempt. Results indicated that declining (negative slope) negative affect, restlessness, and stress predicted quit date abstinence. In addition, increasing positive coping expectancies across the prequit week predicted quit date abstinence. CONCLUSIONS: Study findings highlight multiple variables that may be targeted during the precessation period to increase smoking cessation attempts in this difficult to treat population of smokers.

Cano, Miguel Angel; Lam, Cho Y.; Chen, Minxing; Adams, Claire E.; Correa-Fernandez, Virmarie; Stewart, Diana W. et al. (2014): Positive smoking outcome expectancies mediate the association between negative affect and smoking urge among women during a quit attempt. In: Exp Clin Psychopharmacol. DOI: 10.1037/a0036749.

Ecological momentary assessment was used to examine associations between negative affect, positive smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 302 female smokers who enrolled in an individually tailored smoking cessation treatment study. Multilevel mediation analysis was used to examine the temporal relationship among the following: (a) the effects of negative affect and positive smoking outcome expectancies at 1 assessment point (e.g., time j) on smoking urge at the subsequent time point (e.g., time j + 1) in Model 1; and, (b) the effects of negative affect and smoking urge at time j on positive smoking outcome expectancies at time j + 1 in Model 2. The results from Model 1 showed a statistically significant effect of negative affect at time j on smoking urge at time j + 1, and this effect was mediated by positive smoking outcome expectancies at time j, both within- and between-participants. In Model 2, the within-participant indirect effect of negative affect at time j on positive smoking outcome expectancies at time j + 1 through smoking urge at time j was nonsignificant. However, a statistically significant indirect between-participants effect was found in Model 2. The findings support the hypothesis that urge and positive smoking outcome expectancies increase as a function of negative affect, and suggest a stronger effect of expectancies on urge as opposed to the effect of urge on expectancies.

Casamassima, Filippo; Ferrari, Alberto; Milosevic, Bojan; Ginis, Pieter; Farella, Elisabetta; Rocchi, Laura (2014): A wearable system for gait training in subjects with Parkinson’s disease. In: Sensors (Basel) 14 (4), S. 6229–6246. DOI: 10.3390/s140406229.

In this paper, a system for gait training and rehabilitation for Parkinson’s disease (PD) patients in a daily life setting is presented. It is based on a wearable architecture aimed at the provision of real-time auditory feedback. Recent studies have, in fact, shown that PD patients can receive benefit from a motor therapy based on auditory cueing and feedback, as happens in traditional rehabilitation contexts with verbal instructions given by clinical operators. To this extent, a system based on a wireless body sensor network and a smartphone has been developed. The system enables real-time extraction of gait spatio-temporal features and their comparison with a patient’s reference walking parameters captured in the lab under clinical operator supervision. Feedback is returned to the user in form of vocal messages, encouraging the user to keep her/his walking behavior or to correct it. This paper describes the overall concept, the proposed usage scenario and the parameters estimated for the gait analysis. It also presents, in detail, the hardware-software architecture of the system and the evaluation of system reliability by testing it on a few subjects.

Chastin, S F M; Mandrichenko, O.; Helbostadt, J. L.; Skelton, D. A. (2014): Associations between objectively-measured sedentary behaviour and physical activity with bone mineral density in adults and older adults, the NHANES study. In: Bone 64, S. 254–262. DOI: 10.1016/j.bone.2014.04.009.

BACKGROUND: Lack of physical activity (PA) is an important modifiable risk factor for bone mineral density (BMD). Time spent in sedentary behaviour (SB), or time spent in non-exercising seated and reclining postures, has recently emerged as a new public health risk, independent of the amount of time someone spends being active. As national surveys report that adults spend on average 8h per day being sedentary, rising to 10h a day in older age, it has been hypothesised that a repeated exposure to sitting in modern daily life, whether it is for travelling, working or leisure, might have a deleterious effect on bone health in a way that mirrors the results of studies into the effect of lengthy periods of bed-rest. The aim of this study was to investigate for the first time a) how time spent in SB is associated with bone mineral density (BMD), b) whether this association changes depending on the amount of time spent engaging in different intensity levels of PA, and c) if the pattern of accumulation of SB and long uninterrupted periods of SB are associated with BMD. METHODS: The 2005/2006 National Health and Nutrition Examination Survey (NHANES), is a cross-sectional study of a representative sample of the US population that is conducted biannually by the National Centers for Disease Control. PA and SB were assessed objectively over 7days using an Actigraph accelerometer and BMD was measured via dual-energy X-ray absorptiometry. In this study, data are presented on four regions of the femur (femoral neck, trochanter, inter trochanter and total femur) and total spine (L1-L4). The associations between BMD, SB and PA levels were examined using multiple linear regressions stratified by gender. In addition, the association between the pattern of accumulation of SB (quantified as frequency and duration of SB) and BMD was also investigated. All models were adjusted for known risk factors associated with BMD. In total, data for 2117 individuals, aged 23-90+years (males N=1158), were available to analyse SB and femur BMD and 1942 individuals (males N=1053) for analysis of SB and spine BMD. RESULTS: There was no evidence of an association between SB time and hip or spinal BMD in men. For men, time spent doing moderate to vigorous activity (MVPA) and vigorous activity (VIG) was associated with higher total femur and the other hip sub-region BMD. The regression coefficient was BMVPA=0.306 (95% CI: 0.021-0.591)g/cm(2) for each 10minute increment in daily MVPA. For VIG, the regression coefficient is BVIG=0.320 (95% CI: 0.058-0.583) but this cannot be interpreted linearly as time spent in vigorous activity was square root transformed. In women, SB was negatively associated with total femur BMD and all sub-regions but not MVPA nor VIG. The regression coefficient for total femur BMD was BSB=-0.159 (95% CI: -0.241-0.076)g/cm(2) for each 10minute increment spent being sedentary each day. In addition, the duration of SB bouts was deleteriously associated with BMD for the total femur and of other hip sub-regions, but the number of bouts of SB did not have a significant effect. These associations were found to be independent of the amount of MVPA and VIG that women engage in. No associations were found between SB or PA and spinal BMD for either men or women. CONCLUSIONS: These results provide the first evidence that repeated exposure to sitting (SB), measured objectively in daily life, is deleteriously associated with BMD of the total femur and of all hip sub-regions in women, independent of the amount of time women engage in moderate and vigorous activity. This suggests that SB might be a risk factor for bone health in women independent of whether they engage in physical activity. In addition, the duration of SB bouts, rather than their frequency, appears to be deleteriously associated with BMD of the total femur and of all hip sub-regions. Future research should investigate the effect on bone health of interventions which set out to reduce SB and the duration of SB bouts in comparison, and as adjunct, to the promotion of PA. For men, SB is not significantly associated with BMD of the femur or spine and the results appear to confirm that moderate and vigorous activity has a protective effect.

Cheatham, Scott W.; Kolber, Morey J.; Ernst, Michael P. (2014): The Concurrent Validity of Resting Pulse Rate Measurements: A Comparison of Two Smartphone Applications, Polar H7 Belt Monitor, and Pulse Oximeter with Bluetooth(R). In: J Sport Rehabil. DOI: 10.1123/jsr.2013-0145.

CONTEXT: Pulse rate is commonly measured manually or with commercial wrist or belt monitors. More recently, pulse rate monitoring has become convenient with the use of mobile technology that allows monitoring through the smartphone camera. This optical technology offers many benefits, albeit the clinimetric properties have not been extensively studied. DESIGN: Observational study of reliability Setting: University kinesiology laboratory. PARTICIPANTS: Thirty healthy, recreationally active adults. INTERVENTION: Concurrent measurement of pulse rate using two smartphone applications (Fingertip, Face-scan,) with the Polar(R) H7 belt and pulse oximeter. MAIN OUTCOME MEASURE: Average resting pulse rate for 5 minutes in three positions (supine, sitting, and prone). RESULTS: Concurrent validity in supine and standing was good between the two applications and the Polar H7 (intraclass correlation coefficient: ICC-0.80-0.98) and pulse oximeter (ICC-0.82-0.98). For sitting, the validity was good between the fingertip application, Polar H7 (ICC-0.97) and pulse oximeter (ICC-0.97). The face-scan application had moderate validity with the Polar H7 (ICC-0.74) and pulse oximeter (ICC-0.69). The minimal detectable change (MDC90) between the fingertip application and Polar H7 ranged from 1.38-4.36 beats per minute (BPM) and 0.69-2.97 BPM for the pulse oximeter with all three positions. The MDC90 between the face-scan application and Polar H7 ranged from 11.88-12.83 BPM and 0.59-17.72 BPM for the pulse oximeter. The 95% limits of agreement (LOA) suggests that the fingertip application may vary between 2.40-3.59 BPM with the Polar H7 and 3.40-3.42 BPM with the pulse oximeter. The face-scan application may vary between 3.46-3.52 BPM with the Polar H7 and 2.54-3.46 BPM with the pulse oximeter. CONCLUSION: Pulse rate measurements may be effective using a finger-tip application, belt monitor, and pulse oximeter. The fingertip scanner showed superior results compared to the face-scanner which only demonstrated modest validity when compared to the Polar H7 and pulse oximeter.

Chen, Yu-Wei; Bundy, Anita; Cordier, Reinie; Einfeld, Stewart (2014): Feasibility and usability of experience sampling methodology for capturing everyday experiences of individuals with autism spectrum disorders. In: Disabil Health J 7 (3), S. 361–366. DOI: 10.1016/j.dhjo.2014.04.004.

BACKGROUND: Understanding experiences from the perspective of adults with autism spectrum disorders (ASD), in the myriad of circumstances in which they find themselves every day, is crucial for developing client-centered interventions. However, capturing these experiences can be difficult. OBJECTIVE: To investigate the feasibility and usability of experience sampling method (ESM), an ecological momentary assessment, for studying individuals with ASD. METHODS: Four participants (2 males) with Asperger’s syndrome or high functioning autism aged 16-32 years carried an iPod touch or iPhone with a pre-installed ESM survey exploring the situation and their perceived internal experiences. Participants were asked to respond to the survey 7 times daily, at random times generated by the device, for 7 days. RESULTS: A high signal response rate (mean = 71%) and a short average time required for survey completion (mean = 1 min 42 s) supported feasibility of the ESM for use in research with individuals with ASD. Participants reported that the questions were straightforward and that survey completion interfered very little with everyday activities, supporting acceptability of the method. Results of a split-week analysis revealed consistency of experiences; correlations among experiences that are linked logically provided evidence of the internal logic of data gathered using the ESM. Through graphic analysis, we illustrated the usability of ESM for capturing the influence of everyday contexts on internal experiences/perceptions. CONCLUSIONS: The ESM holds promise for examining the impact of social context on the everyday experiences of individuals with ASD.

Cho, Jaehee; Park, Dongjin; Lee, H. Erin (2014): Cognitive factors of using health apps: systematic analysis of relationships among health consciousness, health information orientation, eHealth literacy, and health app use efficacy. In: J Med Internet Res 16 (5), S. e125. DOI: 10.2196/jmir.3283.

BACKGROUND: Interest in smartphone health apps has been increasing recently. However, we have little understanding of the cognitive and motivational factors that influence the extent of health-app use. OBJECTIVE: This study aimed to examine the effects of four cognitive factors-health consciousness, health information orientation, eHealth literacy, and health-app use efficacy-on the extent of health-app use. It also explored the influence of two different use patterns-information and information-behavior use of health apps-with regard to the relationships among the main study variables. METHODS: We collected and analyzed 765 surveys in South Korea. According to the results, there was a negligible gender difference: males (50.6%, 387/765) and females (49.4%, 378/765). All participants were adults whose ages ranged from 19 to 59. In order to test the proposed hypotheses, we used a path analysis as a specific form of structural equation modeling. RESULTS: Through a path analysis, we discovered that individuals’ health consciousness had a direct effect on their use of health apps. However, unlike the initial expectations, the effects of health information orientation and eHealth literacy on health-app use were mediated by health-app use efficacy. CONCLUSIONS: The results from the path analysis addressed a significant direct effect of health consciousness as well as strong mediating effects of health-app use efficacy. These findings contribute to widening our comprehension of the new, digital dimensions of health management, particularly those revolving around mobile technology.

Cordier, Reinie; Brown, Nicole; Chen, Yu-Wei; Wilkes-Gillan, Sarah; Falkmer, Torbjorn (2014): Piloting the use of experience sampling method to investigate the everyday social experiences of children with Asperger syndrome/high functioning autism. In: Dev Neurorehabil, S. 1–8. DOI: 10.3109/17518423.2014.915244.

Abstract Objective: This pilot study explored the nature and quality of social experiences of children with Asperger Syndrome/High Functioning Autism (AS/HFA) through experience sampling method (ESM) while participating in everyday activities. Methods: ESM was used to identify the contexts and content of daily life experiences. Six children with AS/HFA (aged 8-12) wore an iPod Touch on seven consecutive days, while being signalled to complete a short survey. Results: Participants were in the company of others 88.3% of their waking time, spent 69.0% of their time with family and 3.8% with friends, but only conversed with others 26.8% of the time. Participants had more positive experiences and emotions when they were with friends compared with other company. Participating in leisure activities was associated with enjoyment, interest in the occasion, and having positive emotions. Conclusions: ESM was found to be helpful in identifying the nature and quality of social experiences of children with AS/HFA from their perspective.

Dagoo, Jesper; Asplund, Robert Persson; Bsenko, Helene Andersson; Hjerling, Sofia; Holmberg, Anna; Westh, Susanne et al. (2014): Cognitive behavior therapy versus interpersonal psychotherapy for social anxiety disorder delivered via smartphone and computer: a randomized controlled trial. In: J Anxiety Disord 28 (4), S. 410–417. DOI: 10.1016/j.janxdis.2014.02.003.

In this study, a previously evaluated guided Internet-based cognitive behavior therapy for social anxiety disorder (SAD) was adapted for mobile phone administration (mCBT). The treatment was compared with a guided self-help treatment based on interpersonal psychotherapy (mIPT). The treatment platform could be accessed through smartphones, tablet computers, and standard computers. A total of 52 participants were diagnosed with SAD and randomized to either mCBT (n=27) or mIPT (n=25). Measures were collected at pre-treatment, during the treatment, post-treatment and 3-month follow-up. On the primary outcome measure, the Liebowitz Social Anxiety Scale - self-rated, both groups showed statistically significant improvements. However, mCBT performed significantly better than mIPT (between group Cohen’s d=0.64 in favor of mCBT). A larger proportion of the mCBT group was classified as responders at post-treatment (55.6% versus 8.0% in the mIPT group). We conclude that CBT for SAD can be delivered using modern information technology. IPT delivered as a guided self-help treatment may be less effective in this format.

Direito, Artur; Pfaeffli Dale, Leila; Shields, Emma; Dobson, Rosie; Whittaker, Robyn; Maddison, Ralph (2014): Do physical activity and dietary smartphone applications incorporate evidence-based behaviour change techniques? In: BMC Public Health 14 (1), S. 646. DOI: 10.1186/1471-2458-14-646.

BACKGROUND: There has been a recent proliferation in the development of smartphone applications (apps) aimed at modifying various health behaviours. While interventions that incorporate behaviour change techniques (BCTs) have been associated with greater effectiveness, it is not clear to what extent smartphone apps incorporate such techniques. The purpose of this study was to investigate the presence of BCTs in physical activity and dietary apps and determine how reliably the taxonomy checklist can be used to identify BCTs in smartphone apps. METHODS: The top-20 paid and top-20 free physical activity and/or dietary behaviour apps from the New Zealand Apple App Store Health & Fitness category were downloaded to an iPhone. Four independent raters user-tested and coded each app for the presence/absence of BCTs using the taxonomy of behaviour change techniques (26 BCTs in total). The number of BCTs included in the 40 apps was calculated. Krippendorff’s alpha was used to evaluate interrater reliability for each of the 26 BCTs. RESULTS: Apps included an average of 8.1 (range 2-18) techniques, the number being slightly higher for paid (M = 9.7, range 2-18) than free apps (M = 6.6, range 3-14). The most frequently included BCTs were “provide instruction” (83% of the apps), “set graded tasks” (70%), and “prompt self-monitoring” (60%). Techniques such as “teach to use prompts/cues”, “agree on behavioural contract”, “relapse prevention” and “time management” were not present in the apps reviewed. Interrater reliability coefficients ranged from 0.1 to 0.9 (Mean 0.6, SD = 0.2). CONCLUSIONS: Presence of BCTs varied by app type and price; however, BCTs associated with increased intervention effectiveness were in general more common in paid apps. The taxonomy checklist can be used by independent raters to reliably identify BCTs in physical activity and dietary behaviour smartphone apps.

Doane, Leah D.; Zeiders, Katharine H. (2014): Contextual moderators of momentary cortisol and negative affect in adolescents’ daily lives. In: Journal of Adolescent Health 54 (5), S. 536–542. DOI: 10.1037/t03592-000;

Purpose: To use an ecological momentary assessment design to examine the links between momentary negative affect and cortisol in a sample of adolescents preparing to transition to college. Guided by a risk and resilience framework, we also explored whether important ecological factors, perceived discrimination and social support, moderated the momentary associations between negative affect and youths’ cortisol. Methods: Adolescents (N = 77) provided salivary samples and diary reports of affect and experiences five times a day over 3 days. They also completed self-report questionnaires on perceived discrimination and social support from family and friends. Results: Within-person increases in momentary negative affect were associated with increases in cortisol. Perceived discrimination and social support from friends moderated this association. Adolescents who reported average and high levels of perceived discrimination experienced exaggerated cortisol responses to negative affect, whereas adolescents who reported low levels of perceived discrimination did not experience significant reactivity to negative affect. In contrast, adolescents who reported high levels of social support from friends experienced attenuated cortisol responses to negative affect compared with adolescents who reported average or low levels of social support from friends. Conclusions: This study contributes to our understanding of youths’ daily socioemotional experiences and physiological reactivity by identifying how perceived discrimination and social support from friends amplified and attenuated, respectively, the effects of negative affect on cortisol reactivity. Examining these processes within adolescents’ naturalistic environments advances our understanding of the moderating role of ecological characteristics in adolescents’ everyday lives.

Dulin, Patrick L.; Gonzalez, Vivian M.; Campbell, Kendra (2014): Results of a pilot test of a self-administered smartphone-based treatment system for alcohol use disorders: usability and early outcomes. In: Subst Abus 35 (2), S. 168–175. DOI: 10.1080/08897077.2013.821437.

BACKGROUND: This paper provides results from a pilot study focused on assessing early-stage effectiveness and usability of a smartphone-based intervention system that provides a stand-alone, self-administered intervention option, the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A). The LBMI-A provided numerous features for intervening with ongoing drinking, craving, connection with supportive others, managing life problems, high-risk location alerting, and activity scheduling. METHODS: Twenty-eight participants, ranging in age from 22 to 45, who met criteria for an alcohol use disorder used an LBMI-A-enabled smartphone for 6 weeks. RESULTS: Participants indicated the LBMI-A intervention modules were helpful in highlighting alcohol use patterns. Tools related to managing alcohol craving, monitoring consumption, and identifying triggers to drink were rated by participants as particularly helpful. Participants also demonstrated significant reductions in hazardous alcohol use while using the system (56% of days spent hazardously drinking at baseline vs. 25% while using the LBMI-A) and drinks per day diminished by 52%. CONCLUSIONS: Implications for system improvement as well as suggestions for designing ecological momentary assessment and intervention systems for substance use disorders are discussed.

Engelen, Lina; Bundy, Anita C.; Lau, Jamie; Naughton, Geraldine; Wyver, Shirley; Bauman, Adrian; Baur, Louise (2014): Understanding Patterns of Young Children’s Physical Activity After School - It’s all About Context: A Cross-Sectional Study. In: J Phys Act Health. DOI: 10.1123/jpah.2013-0153.

BACKGROUND: To promote healthy lifestyles, we need to understand more about the patterns of children’s activities after school. METHODS: Twenty 5-7 year old children and their parents participated in this study. Parents used ‘real-time’ diaries to report children’s activities and contextual information at three randomly selected times per day, over 4 school days. Reporting was repeated after 13 weeks. Simultaneously children wore Actical accelerometers. RESULTS: Approximately 300 simultaneous accelerometer measurements and diary entries were compared. Despite a large range, mean physical activity levels were highest when children engaged in activities generally considered as “active” and lowest for doing “nothing”. However, the range within activities was very large; some children who reported TV/screen time accumulated high accelerometry counts and conversely, some children were practically sedentary during organized sports. Children spent most (78%) of their after school time indoors, but the children were significantly more active outdoors than indoors (t(74.8) = 5.0, p<.001). CONCLUSIONS: Accelerometer data in conjunction with real-time diaries provide a more complete understanding of the value of outdoor play in increasing movement opportunities for children’s after school activities.

Enock, Philip M.; Hofmann, Stefan G.; McNally, Richard J. (2014): Attention bias modification training via smartphone to reduce social anxiety: A randomized, controlled multi-session experiment. In: Cognitive Therapy and Research 38 (2), S. 200–216. DOI: 10.1037/t01760-000;

Testing feasibility and efficacy of psychological treatment via mobile devices is important, given its potential benefits for high-dosage treatment delivery, widespread and inexpensive dissemination, and efficient research methods. We conducted the first randomized controlled trial of attention bias modification training delivered via smartphones, comparing this training to control training in a double-blind design, also including a waitlist condition. All participants performed a variant of dot-probe training involving faces with neutral and disgust (representative of social threat) expressions in brief sessions three times daily over 4 weeks on their own smartphones, at home or anywhere they chose. Attention bias modification, also known as cognitive bias modification of attention, training included a contingency to induce attentional deployment away from disgust faces, whereas the control training included no contingency. Participants completed weekly Internet-based self-report symptom assessments as well as smartphone-delivered dot-probe attention bias assessments, whose reliability findings supported the viability of using smartphones for reaction-time based assessments. The between-groups training effect on attention bias scores was small, showing statistical significance in some analyses and not in others. On measures of social anxiety, intention-to-treat analyses (n = 326) revealed significant pre–post treatment declines with medium to large effect sizes in both training groups, whereas small declines in a waitlist group were nonsignificant. Both training groups showed greater reductions in social anxiety than did waitlist; however, the benefits under these two training conditions were statistically indistinguishable. Improvements in the two training conditions beyond those of waitlist could be attributable to any factors common to them, but not to the contingency training specific to active attention bias modification training.

Epstein, R. S. (2014): Mobile medical applications: old wine in new bottles? In: Clin Pharmacol Ther 95 (5), S. 476–478. DOI: 10.1038/clpt.2014.35.

In Her, the award-winning motion picture written and directed by Spike Jonze, the lead character played by Joaquin Phoenix falls hopelessly in love with an operating system deployed on his many devices, including his mobile telephone. Although the health-care sector has not yet attained that “magic moment” with mobile devices and their applications, there appears to be quite a lot for those in the field to like.

Factor, Perry I.; Reyes, Rachel A.; Rosen, Paul J. (2014): Emotional impulsivity in children with adhd associated with comorbid—not adhd—symptomatology. In: Journal of Psychopathology and Behavioral Assessment. Online verfügbar unter

Children with ADHD often demonstrate sudden and intense shifts in both positive and negative affect. This study examined the role of diagnostic status on emotional impulsivity in children utilizing ecological momentary assessment (EMA). Parents of 64 8–12 year old children (15 ADHD-only; 27 ADHD-comorbid; 22 control) completed a diagnostic structured interview and then an EMA protocol, rating the child’s affect thrice daily for 28 days. Analysis of covariance (ANCOVA) suggested that children with ADHD and a comorbid disorder demonstrated significantly more EMA-derived emotional impulsivity than children with ADHD only and control children. No difference was found between children with ADHD only and control children. This study suggested that children with ADHD demonstrate significantly higher levels of emotional impulsivity than control children only in the presence of a comorbid disorder.

Faurholt-Jepsen, Maria; Frost, Mads; Vinberg, Maj; Christensen, Ellen Margrethe; Bardram, Jakob E.; Kessing, Lars Vedel (2014): Smartphone data as objective measures of bipolar disorder symptoms. In: Psychiatry Research 217 (1-2), S. 124–127. DOI: 10.1037/t04100-000;

The daily electronic self-monitoring Smartphone software “MONARCA” was used by 17 patients with bipolar disorder for 3 consecutive months. Patients were rated fortnightly using Hamilton Depression rating Scale 17 items (HDRS-17) and Young Mania rating Scale (YMRS) (102 ratings) with blinding for Smartphone data. Objective Smartphone measures such as physical and social activity correlated with clinically rated depressive symptoms. Self-monitored depressive symptoms correlated significantly with HDRS-17 items score.

Forman, Daniel E.; LaFond, Karen; Panch, Trishan; Allsup, Kelly; Manning, Kenneth; Sattelmair, Jacob (2014): Utility and Efficacy of a Smartphone Application to Enhance the Learning and Behavior Goals of Traditional Cardiac Rehabilitation: A FEASIBILITY STUDY. In: J Cardiopulm Rehabil Prev. DOI: 10.1097/HCR.0000000000000058.

PURPOSE:: Most eligible patients do not participate in traditional clinic-based cardiac rehabilitation (CR) despite well-established benefits. Novel approaches to overcome logistic obstacles and increase efficiencies of learning, behavior modification, and exercise surveillance may increase CR participation. In an observational study, the feasibility and utility of a mobile smartphone application for CR, Heart Coach (HC), were assessed as part of standard care. Ultimately, innovative CR models incorporating HC may facilitate better CR usage and value. METHODS:: Twenty-six patients enrolled in CR installed HC. Over the next 30 days, they were prompted by HC to complete a daily “task list” that included medications, walking, education (text and videos), and surveys. Cardiac rehabilitation providers monitored each patient’s progress through a HC-based Web dashboard and also sent them personalized feedback and support. Completion of the tasks and feedback (qualitative and quantitative) from patients and clinicians were tracked. RESULTS:: Patients engaged with HC 90% of days during the study period, with uniformly favorable impact on compliance and adherence. Eighty-three percent of patients reported a positive/very positive HC experience. Providers reported that HC enhanced their provision of therapy by improving communication, clinical insight, patient participation, and program efficiency. CONCLUSIONS:: Integrating a mobile care delivery platform into CR was feasible, safe, and agreeable to patients and clinicians. It enhanced patient perceptions of CR care and physician perceptions of the CR caregiving process. Mobile-enabled technologies hold promise to extend the quality and reach of CR, and to better achieve contemporary accountable care goals.

Gadassi, Reuma; Snir, Avigal; Berenson, Kathy; Downey, Geraldine; Rafaeli, Eshkol (2014): Out of the Frying Pan, Into the Fire: Mixed Affective Reactions to Social Proximity in Borderline and Avoidant Personality Disorders in Daily Life. In: Journal of Abnormal Psychology. Online verfügbar unter

Social proximity typically helps individuals meet their belongingness needs, but several forms of psychopathology, including borderline and avoidant personality disorders (BPD and APD, respectively) are characterized by social difficulties. This experience-sampling study is one of the first to directly investigate the affective reactions of individuals with BPD and APD (compared with healthy controls [HC]) to social proximity in daily life. We examined both person-level and day-level reactions. At the person level, the rate of social proximity across the diary period was associated with diminished feelings of rejection, isolation, shame, and dissociation in the HC group. In contrast, it was not associated with any affective reaction in the BPD group, and was associated with decreased rejection and isolation on the one hand, but also with increased anxiety in the APD group. At the day level, we used multilevel regression to examine affective reactions when in social proximity. The HC group showed a consistent benefit when in social proximity. In contrast, both PD groups exhibited mixed affective reactions to social proximity; specifically, benefits (increased positive affect, decreased rejection, isolation, and dissociation) were interspersed with costs (increased shame for both PD groups; increased anger for BPD; increased anxiety for APD). The mixed reactions found in both PDs may contribute to the disturbed relationships of individuals with these disorders.

Garcia-Palacios, A.; Herrero, R.; Belmonte, M. A.; Castilla, D.; Guixeres, J.; Molinari, G.; Banos, R. M. (2014): Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study. In: Eur J Pain 18 (6), S. 862–872.

BACKGROUND: Daily diaries are a useful way of measuring fluctuations in pain-related symptoms. However, traditional diaries do not assure the gathering of data in real time, not solving the problem of retrospective assessment. Ecological momentary assessment (EMA) by means of electronic diaries helps to improve repeated assessment. However, it is important to test its feasibility in specific populations in order to reach a wider number of people who could benefit from these procedures. METHODS: The present study compares the compliance and acceptability of an electronic diary running on a smartphone using a crossover design for a sample with a specific pain condition, fibromyalgia and low familiarity with technology. Forty-seven participants were randomly assigned to one of two conditions: (1) paper diary - smartphone diary and (2) smartphone diary - paper diary, using each assessment method for 1 week. RESULTS: The findings of this study showed that the smartphone diary made it possible to gather more accurate and complete ratings. Besides, this method was well accepted by a sample of patients with fibromyalgia referred by a public hospital, with an important proportion of participants with low level of education and low familiarity with technology. CONCLUSIONS: The findings of this study support the use of smartphones for EMA even in specific populations with a specific pain condition, fibromyalgia and with low familiarity with technology. These methods could help clinicians and researchers to gather more accurate ratings of relevant pain-related variables even in populations with low familiarity with technology.

Gard, David E.; Sanchez, Amy H.; Starr, Jessica; Cooper, Shanna; Fisher, Melissa; Rowlands, Abby; Vinogradov, Sophia (2014): Using self-determination theory to understand motivation deficits in schizophrenia: The ‘why’ of motivated behavior. In: Schizophrenia Research. Online verfügbar unter

Self-Determination Theory (SDT) provides a model for understanding motivation deficits in schizophrenia, and recent research has focused on problems with intrinsic motivation. However, SDT emphasizes that motivated behavior results from three different factors: intrinsic motivators (facilitated by needs for autonomy, competency, and relatedness), extrinsic motivators (towards reward or away from punishment), or when intrinsic and extrinsic motivators are absent or thwarted a disconnect-disengagement occurs resulting in behavior driven by boredom or ‘passing time’. Using a novel approach to Ecological Momentary Assessment, we assessed the degree to which people with schizophrenia were motivated by these factors relative to healthy control participants. Forty-seven people with and 41 people without schizophrenia were provided with cell phones and were called four times a day for one week. On each call participants were asked about their goals, and about the most important reason motivating each goal. All responses were coded by independent raters (blind to group and hypotheses) on all SDT motivating factors, and ratings were correlated to patient functioning and symptoms. We found that, relative to healthy participants, people with schizophrenia reported goals that were: 1) less motivated by filling autonomy and competency needs, but equivalently motivated by relatedness; 2) less extrinsically rewarding, but equivalently motivated by punishment; 3) more disconnected-disengaged. Higher disconnected-disengaged goals were significantly associated with higher negative symptoms and lower functioning. These findings indicate several important leverage points for behavioral treatments and suggest the need for vigorous psychosocial intervention focusing on autonomy, competence, and reward early in the course of illness.

Ginexi, Elizabeth M.; Riley, William; Atienza, Audie A.; Mabry, Patricia L. (2014): The promise of intensive longitudinal data capture for behavioral health research. In: Nicotine Tob Res 16 Suppl 2, S. S73-5. DOI: 10.1093/ntr/ntt273.

Advances in technology and the associated cultural norms, especially the advent of the smartphone, offer an unprecedented opportunity to collect data on relevant health behaviors and experiences unobtrusively at a greater frequency and in greater volumes than ever before. This special issue will acquaint the readership of Nicotine and Tobacco Research with the potential for intensive longitudinal data and will illustrate some innovative analytic techniques for addressing research questions associated with this type of complex data. This introductory article will provide a brief history of the analytic techniques for intensive longitudinal data and will point to some resources that support and enable the use of these techniques.

Goetz, Thomas; Frenzel, Anne C.; Hall, Nathan C.; Nett, Ulrike E.; Pekrun, Reinhard; Lipnevich, Anastasiya A. (2014): Types of boredom: An experience sampling approach. In: Motivation and Emotion 38 (3), S. 401–419. Online verfügbar unter

The present study investigated different types of boredom as proposed in a four-categorical conceptual model by Goetz and Frenzel (2006; doi:10.1026/0049-8637.38.4. 149). In this model, four types of boredom are differentiated based on degrees of valence and arousal: indifferent, calibrating, searching, and reactant boredom. In two studies (Study 1: university students, N = 63, mean age 24.08 years, 66 % female; Study 2: high school students, grade 11, N = 80, mean age 17.05 years, 58 % female), real-time data were obtained via the experience-sampling method (personal digital assistants, randomized signals). Boredom experiences (N = 1,103/1,432 in Studies 1/2) were analyzed with respect to the dimensions of valence and arousal using multilevel latent profile analyses. Supporting the internal validity of the proposed boredom types, our results are in line with the assumed four types of boredom but suggest an additional, fifth type, referred to as “apathetic boredom.” The present findings further support the external validity of the five boredom types in showing differential relations between the boredom types and other affective states as well as frequency of situational occurrence (achievement contexts vs. non-achievement contexts). Methodological implications as well as directions for future research are discussed.

Goldbogen, Jeremy A.; Stimpert, Alison K.; Deruiter, Stacy L.; Calambokidis, John; Friedlaender, Ari S.; Schorr, Greg S. et al. (2014): Using accelerometers to determine the calling behavior of tagged baleen whales. In: J Exp Biol. DOI: 10.1242/jeb.103259.

Low-frequency acoustic signals generated by baleen whales can propagate over vast distances, making the assignment of calls to specific individuals problematic. Here we report the novel use of acoustic recording tags equipped with high-resolution accelerometers to detect vibrations on the surface of two tagged fin whales that directly match the timing of recorded acoustic signals. A tag deployed on a buoy in the vicinity of calling fin whales, and a recording from a tag that had just fallen off of a whale, were able to detect calls acoustically but did not record corresponding accelerometer signals that were measured on calling individuals. Across the hundreds of calls measured on two tagged fin whales, the accelerometer response was generally anisotropic across all three axes, appeared to depend on tag placement, and increased with the level of received sound. These data demonstrate that high-sample-rate accelerometry can provide important insights into the acoustic behavior of baleen whales that communicate at low frequencies. This method helps identify vocalizing whales, which in turn enables the quantification of call rates, a fundamental component of models used to estimate baleen whale abundance and distribution from passive acoustic monitoring.

Goldschmidt, Andrea B.; Crosby, Ross D.; Engel, Scott G.; Crow, Scott J.; Cao, Li; Peterson, Carol B.; Durkin, Nora (2014): Affect and eating behavior in obese adults with and without elevated depression symptoms. In: International Journal of Eating Disorders 47 (3), S. 281–286. DOI: 10.1037/t00742-000;

Objective: Although there is a modest relation between obesity and depression, mechanisms that contribute to this co-occurrence are unclear. This study examined mood and eating behavior among obese adults with and without elevated depression symptoms. Method: Obese adults (N = 50) were subtyped according to a Beck Depression Inventory (BDI) cutoff of 14, indicating “probable depression.” Participants with (BDI ≥ 14; n = 15) and without (BDI < 14; n = 35) elevated depression symptoms were compared on affect- and eating-related variables measured via questionnaire and ecological momentary assessment (EMA) using ANCOVA and mixed model regression. Results: After adjusting for group differences in body mass index (BMI; p = .03), participants with elevated depression symptoms reported greater emotional eating via self-report questionnaire [F(1,50) = 4.3; p = .04], as well as more frequent binge eating (Wald χ² = 13.8; p < .001) and higher daily negative affect (Wald χ² = 7.7; p = .005) on EMA recordings. Emotional eating mediated the relationship between depression status and BMI (indirect effect estimate = 3.79; 95% CI = 1.02–7.46). Discussion: Emotional eating and binge eating were more commonly reported by obese adults with elevated depression symptoms compared to those without and may occur against a general backdrop of overall low mood. Intervention and prevention programs for obesity and/or depression should address disordered eating to prevent or minimize adverse health consequences.

Goldschmidt, Andrea B.; Wonderlich, Stephen A.; Crosby, Ross D.; Cao, Li; Engel, Scott G.; Lavender, Jason M. et al. (2014): Latent profile analysis of eating episodes in anorexia nervosa. In: Journal of Psychiatric Research 53, S. 193–199. DOI: 10.1037/t04751-000;

Background: Despite being characterized primarily by disturbances in eating behavior, relatively little is known about specific eating behaviors in anorexia nervosa (AN) and how they relate to different emotional, behavioral, and environmental features. Methods: Women with AN (n = 118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on daily eating- and mood-related patterns. Latent profile analysis was used to identify classes of eating episodes based on the presence or absence of the following indicators: loss of control; overeating; eating by oneself; food avoidance; and dietary restraint. Results: The best-fitting model supported a 5-class solution: avoidant eating; solitary eating; binge eating; restrictive eating; and loss of control eating. The loss of control and binge eating classes were characterized by high levels of concurrent negative affect and a greater likelihood of engaging in compensatory behaviors. The restrictive eating class was associated with the greatest number of concurrently-reported stressful events, while the avoidant and solitary eating episode classes were characterized by relatively few accompanying stressful events. Body checking was least likely to occur in conjunction with restrictive eating behaviors. Conclusions: Results support the presence of discrete types of eating episodes in AN that are associated with varying degrees of negative affect, stress, and behavioral features of eating disorders. Loss of control and dietary restriction may serve distinct functional purposes in AN, as highlighted by their differing associations with negative affect and stress. Clinical interventions for AN may benefit from targeting functional aspects of eating behavior among those with the disorder.

Gorman, E.; Hanson, H. M.; Yang, P. H.; Khan, K. M.; Liu-Ambrose, T.; Ashe, M. C. (2014): Accelerometry analysis of physical activity and sedentary behavior in older adults: a systematic review and data analysis. In: Eur Rev Aging Phys Act 11, S. 35–49. DOI: 10.1007/s11556-013-0132-x.

Accelerometers objectively monitor physical activity and sedentary patterns and are increasingly used in the research setting. It is important to maintain consistency in data analysis and reporting, therefore, we: (1) systematically identified studies using accelerometry (ActiGraph, Pensacola, FL, USA) to measure moderate-to-vigorous physical activity (MVPA) and sedentary time in older adults, and (2) based on the review findings, we used different cut-points obtained to analyze accelerometry data from a sample of community-dwelling older women. We identified 59 articles with cut-points ranging between 574 and 3,250 counts/min for MVPA and 50 and 500 counts/min for sedentary time. Using these cut-points and data from women (mean age, 70 years), the median MVPA minutes per day ranged between 4 and 80 min while percentage of sedentary time per day ranged between 62 % and 86 %. These data highlight (1) the importance of reporting detailed information on the analysis assumptions and (2) that results can differ greatly depending on analysis parameters.

Hare, Dougal J.; Wood, Christopher; Wastell, Sarah; Skirrow, Paul (2014): Anxiety in Asperger’s syndrome: Assessment in real time. In: Autism. DOI: 10.1177/1362361314531340.

Anxiety is a major problem for many people with Asperger’s syndrome who may have qualitatively different fears from a non-Asperger’s syndrome population. Research has relied on measures developed for non-Asperger’s syndrome populations that require reporting past experiences of anxiety, which may confound assessment in people with Asperger’s syndrome due to problems with autobiographical memory as are often reported in this group.Experience sampling methodology was used to record real-time everyday experiences in 20 adults with Asperger’s syndrome and 20 neurotypical adults. Within-subject analysis was used to explore the phenomenology of thoughts occurring in people with Asperger’s syndrome when they were anxious. Comparisons were made with the group that did not have Asperger’s syndrome. The Asperger’s syndrome group were significantly more anxious than the comparison group. Factors associated with feelings of anxiety in the Asperger’s syndrome group were high levels of self-focus, worries about everyday events and periods of rumination lasting over 10 min. People in the Asperger’s syndrome group also had a tendency to think in the image form, but this was not associated with feelings of anxiety. The results are discussed with reference to psychological models of Asperger’s syndrome, cognitive models of anxiety and implications for psychological therapy for this group.

Heron, Kristin E.; Scott, Stacey B.; Sliwinski, Martin J.; Smyth, Joshua M. (2014): Eating behaviors and negative affect in college women’s everyday lives. In: Int J Eat Disord. DOI: 10.1002/eat.22292.

OBJECTIVE: A growing body of research seeks to understand the relationship between mood and eating behaviors. Ecological Momentary Assessment (EMA) methods provide a method for assessing these processes in natural settings. We used EMA to examine the relationship between mood and eating behaviors in everyday life among women with subclinical disordered eating behaviors. METHOD: Participants (N = 127, age M = 19.6 years, BMI M = 25.5) completed five daily EMA reports on palmtop computers for 1 week. Assessments included measures of negative affect (NA) and eating-related behavior during eating (eating large amounts of food, loss of control over eating, and restricting food intake) and noneating episodes (skip eating to control weight/shape). Time-lagged multilevel models tested mood-eating behavior relationships. RESULTS: Higher NA did not precede any unhealthy eating and weight control behaviors. However, NA was higher when women reported eating large quantities of food, losing control over eating, and restricting food intake during their most recent eating episode, but not after skipping eating to control weight/shape. DISCUSSION: These findings elucidate the processes in daily life that may influence the development and maintenance of unhealthy eating and weight control behaviors that, in turn, can inform interventions. (c) 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).

Holden, George W.; Williamson, Paul A.; Holland, Grant W. O. (2014): Eavesdropping on the family: A pilot investigation of corporal punishment in the home. In: Journal of Family Psychology 28 (3), S. 401–406. Online verfügbar unter

This study tested the feasibility of using audio recorders to collect novel information about family interactions. Research into corporal punishment (CP) has relied, almost exclusively, on self-report data; audio recordings have the promise of revealing new insights into the use and immediate consequences of CP. So we could hear how parents respond to child conflicts, 33 mothers wore digital audio recorders for up to 6 evenings. We identified a total of 41 CP incidents, in 15 families and involving 22 parent–child dyads. These incidents were evaluated on 6 guidelines culled from the writings of CP advocates. The results indicated, contrary to advice, CP was not being used in line with 3 of the 6 recommendations and for 2 others, the results were equivocal. The last recommendation could not be assessed with audio. Latency analyses revealed children, after being hit, were misbehaving again within 10 minutes after 73% of the incidents. Mothers’ self reports about whether they used CP were found to correspond to the audio data in 81% of the cases. Among the mothers who were hitting, CP occurred at a much higher rate than the literature indicates. These results should be viewed as preliminary because of the small sample of families and the even smaller number of families who used CP. Nevertheless, this pilot study demonstrates that audio recording naturally occurring momentary processes in the family is a viable method for collecting new data to address important questions about family interactions.

Holmes, Millicent; Fuller-Tyszkiewicz, Matthew; Skouteris, Helen; Broadbent, Jaclyn (2014): Tests of an extension of the dual pathway model of bulimic symptoms to the state-based level. In: Eat Behav 15 (2), S. 280–285. DOI: 10.1016/j.eatbeh.2014.03.011.

The dual pathway model proposes that trait body dissatisfaction leads to bulimic symptoms via two distinct pathways: dieting and trait negative affect. As many of these modelled variables have state-based equivalents, the present study evaluated the generalisability of this model to predict associations between state body dissatisfaction and instances of disordered eating. 124 women aged 18 to 40 years completed an online survey (accessed via a mobile phone device with web access) over a 7-day period. The mobile phone device prompted participants at random intervals seven times daily to self-report their state body dissatisfaction, current mood experiences, dieting attempts, and disordered eating practices. Multi-level mediation modelling revealed that both negative mood states and dieting significantly mediated the state body dissatisfaction-disordered eating relationships, although the strength of these associations depended on the aspect of disordered eating measured and individual differences in trait body dissatisfaction, internalization of appearance standards, tendency towards dieting, and BMI. Collectively, these results not only support adapting the dual pathway model to the state-level, but also suggest that several of the model implied pathways may be more relevant for individuals with more pathological eating- and body-related concerns and behaviours.

Huh, Jimi; Shin, Heesung; Leventhal, Adam M.; Spruijt-Metz, Donna; Abramova, Zarina; Cerrada, Christian et al. (2014): Momentary Negative Moods and Being With Friends Precede Cigarette Use Among Korean American Emerging Adults. In: Nicotine Tob Res. DOI: 10.1093/ntr/ntu063.

INTRODUCTION: The objective of this study was to determine contextual antecedents to smoking among Korean American emerging adult (KAEA) smokers, using ecological momentary assessment. Based on extant theory and data documenting the importance of negative affect (NA) and social context, we examined the extent to which being with friends and NA independently and concomitantly were associated with the likelihood of subsequent smoking, over and beyond other known situational correlates of smoking. METHODS: Twenty-two KAEA daily smokers recorded their smoking events in real time and participated in short surveys implemented on mobile phones for 7 days. Individual, interpersonal, and situational contexts immediately preceding and during smoking events were examined in comparison to nonsmoking events using a within-subject modeling approach. RESULTS: Both NA and being with friends independently were correlated with increased likelihood of smoking. We also found an interaction showing that the effects of NA on smoking were significant only in presence of friends. CONCLUSIONS: Unlike more established smokers, these younger smokers may be strongly influenced by peer contexts as well as unpleasant affect. The interaction between social contexts and NA highlights a potential window for intervention for the population of KAEA smokers.

Jasper, Fabian; Hiller, Wolfgang; Berking, Matthias; Rommel, Thilo; Witthoft, Michael (2014): The affective response to health-related information and its relationship to health anxiety: An ambulatory approach. In: Cogn Emot, S. 1–9. DOI: 10.1080/02699931.2014.930022.

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

Juth, Vanessa; Dickerson, Sally S.; Zoccola, Peggy M.; Lam, Suman (2014): Understanding the utility of emotional approach coping: evidence from a laboratory stressor and daily life. In: Anxiety Stress Coping, S. 1–21. DOI: 10.1080/10615806.2014.921912.

Background: Dispositional emotional approach coping (EAC) marks an adaptive tendency to process and express emotions. EAC’s association with cognitions, affect, and intra- and interindividual characteristics that may account for its utility was examined in response to an acute stressor and in daily life. Design: This study included a laboratory stress task and ecological momentary assessment. Methods: Healthy undergraduate students (n = 124; mean age: 20; women: 56%) completed a laboratory component (baseline survey, speech stress task, pre- and posttask measures) and five subsequent days of surveys via palm pilot (six surveys/day). Results: Controlling for sex, neuroticism, and social support, greater EAC was associated with more positive cognitive appraisals, personal resources, and positive affect and less-negative affect during the lab stressor, and with more perceived control and positive affect in daily life. Significant EAC x sex interactions were found for poststressor affect: men with high EAC reported more positive affect and women with high EAC reported less negative affect. Conclusions: Findings provide support that EAC’s utility may be independent of intra- and interindividual characteristics, and that men and women may benefit from EAC in different ways in regards to affect. The proclivity to use EAC may come with a resiliency that protects against stress and promotes general well-being.

Kashdan, Todd B.; Farmer, Antonina S. (2014): Differentiating emotions across contexts: Comparing adults with and without social anxiety disorder using random, social interaction, and daily experience sampling. In: Emotion 14 (3), S. 629–638. DOI: 10.1037/t00532-000.

The ability to recognize and label emotional experiences has been associated with well-being and adaptive functioning. This skill is particularly important in social situations, as emotions provide information about the state of relationships and help guide interpersonal decisions, such as whether to disclose personal information. Given the interpersonal difficulties linked to social anxiety disorder (SAD), deficient negative emotion differentiation may contribute to impairment in this population. We hypothesized that people with SAD would exhibit less negative emotion differentiation in daily life, and these differences would translate to impairment in social functioning. We recruited 43 people diagnosed with generalized SAD and 43 healthy adults to describe the emotions they experienced over 14 days. Participants received palmtop computers for responding to random prompts and describing naturalistic social interactions; to complete end-of-day diary entries, they used a secure online website. We calculated intraclass correlation coefficients to capture the degree of differentiation of negative and positive emotions for each context (random moments, face-to-face social interactions, and end-of-day reflections). Compared to healthy controls, the SAD group exhibited less negative (but not positive) emotion differentiation during random prompts, social interactions, and (at trend level) end-of-day assessments. These differences could not be explained by emotion intensity or variability over the 14 days, or to comorbid depression or anxiety disorders. Our findings suggest that people with generalized SAD have deficits in clarifying specific negative emotions felt at a given point of time. These deficits may contribute to difficulties with effective emotion regulation and healthy social relationship functioning.

Kashdan, Todd B.; Yarbro, Jessica; McKnight, Patrick E.; Nezlek, John B. (2014): Corrigendum to ‘Laughter with someone else leads to future social rewards: Temporal change using experience sampling methodology.’. In: Personality and Individual Differences 61-62, S. 109. Online verfügbar unter

Reports an error in “Laughter with someone else leads to future social rewards: Temporal change using experience sampling methodology” by Todd B. Kashdan, Jessica Yarbro, Patrick E. McKnight and John B. Nezlek (Personality and Individual Differences, Advanced Online Publication, Oct 15, 2013, np). In the original article, there was an error in the affiliation of the author John B. Nezlek. The corrected affiliation is present in the erratum. (The following abstract of the original article appeared in record [rid]2013-36550-001[/rid]). Prior research suggests that laughter is correlated with resilience and well-being. To date, there is little research on the subsequent social benefits following laughter with another person. We hypothesized that laughing with another person would be associated with greater social rewards in subsequent social interactions. Using a two-week daily diary study with 162 people (68% women), we collected data on 5510 face-to-face social interactions in everyday life. We found that laughing with another person during an interaction predicted greater intimacy, positive emotions, and enjoyment in the subsequent social interaction. There was no evidence for the reverse direction, as intimacy, positive emotions, and enjoyment failed to predict laughter in subsequent social interactions. As for specificity, laughter was associated with subsequent intimacy and positive emotions even after accounting for the variance attributable to enjoyment felt when socializing. As for robustness, laughter with another person had the same effect on subsequent interactions regardless of whether interacting with the same person or a new person. In summary, besides being immediately pleasurable, laughing with social interaction partners influences the likelihood of future social rewards. This study adds to theory and research suggesting that laughing is an important social bonding mechanism.

Khan, Tareq Hasan; Shrestha, Ravi; Wahid, Khan A. (2014): A modular and programmable development platform for capsule endoscopy system. In: J Med Syst 38 (6), S. 57. DOI: 10.1007/s10916-014-0057-6.

The state-of-the-art capsule endoscopy (CE) technology offers painless examination for the patients and the ability to examine the interior of the gastrointestinal tract by a noninvasive procedure for the gastroenterologists. In this work, a modular and flexible CE development system platform consisting of a miniature field programmable gate array (FPGA) based electronic capsule, a microcontroller based portable data recorder unit and computer software is designed and developed. Due to the flexible and reprogrammable nature of the system, various image processing and compression algorithms can be tested in the design without requiring any hardware change. The designed capsule prototype supports various imaging modes including white light imaging (WLI) and narrow band imaging (NBI), and communicates with the data recorder in full duplex fashion, which enables configuring the image size and imaging mode in real time during examination. A low complexity image compressor based on a novel color-space is implemented inside the capsule to reduce the amount of RF transmission data. The data recorder contains graphical LCD for real time image viewing and SD cards for storing image data. Data can be uploaded to a computer or Smartphone by SD card, USB interface or by wireless Bluetooth link. Computer software is developed that decompresses and reconstructs images. The fabricated capsule PCBs have a diameter of 16 mm. An ex-vivo animal testing has also been conducted to validate the results.

Kimhy, David; Vakhrusheva, Julia; Khan, Samira; Chang, Rachel W.; Hansen, Marie C.; Ballon, Jacob S. et al. (2014): Emotional granularity and social functioning in individuals with schizophrenia: An experience sampling study. In: Journal of Psychiatric Research 53, S. 141–148. DOI: 10.1037/t15180-000;

Previous research has shown that healthy individuals who fail to differentiate among emotional states (i.e., those with low emotional granularity; EG) have poorer social functioning (SF) than those with high EG. It is unknown, however, whether these associations extend to clinical disorders characterized by impaired SF, such as schizophrenia. In the present study, we compared SF and EG in individuals with schizophrenia and healthy controls, and then, within the schizophrenia group, we examined the links between EG and SF. Employing an Experience Sampling Method approach, 77 individuals with schizophrenia and 27 healthy controls rated their momentary emotions (sadness, anxiety, anger, and happiness) up to 10 times/day over a two-day period using mobile electronic devices. For each participant, we then calculated the within-subject average correlations among the momentary emotion ratings, producing two EG indices—EGIall for all emotions and EGIneg for negative ones. A subsample of participants with schizophrenia also completed self-report, interview, and ability-based measures of SF. Compared to healthy controls, individuals with schizophrenia displayed significantly poorer SF and lower EGIall, but comparable EGIneg. Within the schizophrenia group, hierarchical multiple regression analyses indicated that EGIall, but not EGIneg, significantly predicted social dysfunction after controlling for emotional awareness, symptoms, and emotional intensity and variability. Our findings indicate that individuals with schizophrenia have a relatively intact ability to differentiate among negative emotions in everyday life. However, they experience significant difficulties differentiating between positive and negative emotions, and this may contribute to their social difficulties.

King, Eden B.; Mohr, Jonathan J.; Peddie, Chad I.; Jones, Kristen P.; Kendra, Matt (2014): Predictors of identity management: An exploratory experience-sampling study of lesbian, gay, and bisexual workers. In: Journal of Management. Online verfügbar unter

This study examined workplace interactions in which lesbian, gay, and bisexual (LGB) workers faced decisions related to revealing or concealing their LGB identities at work (i.e., identity management situations). Participants were 61 LGB adults who completed a baseline survey about their organization and, over 3 weeks, responded to event-based surveys immediately after identity management situations. Results suggested that LGB workers manage their stigmatized identity strategically according to situational characteristics. Indeed, much of the variance in use of revealing and concealing strategies was due to differences within people from situation to situation. Use of identity management strategies was predicted by interaction partner cues of acceptance or rejection as well as perception of LGB-related organizational climate and policies. Results at the within-person and between-person levels diverged in noteworthy ways.

Kolar, David Raphael; Burger, Arne; Hammerle, Florian; Jenetzky, Ekkehart (2014): Aversive tension of adolescents with anorexia nervosa in daily course: a case-controlled and smartphone-based ambulatory monitoring trial. In: BMJ Open 4 (4), S. e004703. DOI: 10.1136/bmjopen-2013-004703.

INTRODUCTION: Monitoring and reduction of aversive tension is a core issue in dialectical behaviour therapy of patients. It has been shown that aversive tension is increased in adult borderline personality disorder and is linked to low emotion labelling ability. However, until now there is no documented evidence that patients with anorexia nervosa suffer from aversive tension as well. Furthermore the usability of a smartphone application for ambulatory monitoring purposes has not been sufficiently explored. METHODS AND ANALYSIS: We compare the mean and maximum self-reported aversive tension in 20 female adolescents (12-19 years) with anorexia nervosa in outpatient treatment with 20 healthy controls. They are required to answer hourly, over a 2-day period, that is, about 30 times, four short questions on their smartphone, which ensures prompt documentation without any recall bias. At the close out, the participants give a structured usability feedback on the application and the procedure. ETHICS AND DISSEMINATION: The achieved result of this trial has direct relevance for efficient therapy strategies and is a prerequisite for trials regarding dialectical behaviour therapy in anorexia nervosa. The results will be disseminated through peer-review publications. The ethics committee of the regional medical association in Mainz, Germany approved the study protocol under the reference number 837.177.13. TRIAL REGISTRATION NUMBER: The trial is registered at the German clinical trials registration under the reference number DRKS00005228.

Lam, Cho Y.; Businelle, Michael S.; Cofta-Woerpel, Ludmila; McClure, Jennifer B.; Cinciripini, Paul M.; Wetter, David W. (2014): Positive smoking outcome expectancies mediate the relation between alcohol consumption and smoking urge among women during a quit attempt. In: Psychol Addict Behav 28 (1), S. 163–172. DOI: 10.1037/a0034816.

Social learning models of addiction hypothesize that situational factors interact with cognitive determinants to influence a person’s motivation to use substances. Ecological momentary assessment was used to examine the association between alcohol consumption, smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 113 female smokers who enrolled in a study that tested an individually tailored smoking cessation treatment. Participants carried a palm-top personal computer for 7 days and were instructed to complete 4 random assessments each day and to initiate an assessment when they were tempted to smoke. Multilevel mediational analyses were used to examine (a) the effects of alcohol consumption before time j and positive smoking outcome expectancies at time j on smoking urge at time j + 1 (Model 1) and (b) the effects of alcohol consumption before time j and smoking urge at time j on positive smoking outcome expectancies at time j + 1 (Model 2). Model 1 found a significant effect of alcohol consumption before time j on smoking urge at time j + 1 (p = .04), and this effect was significantly mediated by positive smoking outcome expectancies at time j (p < .0001). Model 2 failed to find a significant effect of alcohol consumption before time j on positive smoking outcome expectancies at time j + 1. The findings suggest that alcohol consumption is significantly associated with increased positive smoking outcome expectancies that, in turn, are associated with increased smoking urge in women seeking to quit smoking.

Lanaj, Klodiana; Johnson, Russell E.; Barnes, Christopher M. (2014): Beginning the workday yet already depleted? Consequences of late-night smartphone use and sleep. In: Organizational Behavior and Human Decision Processes 124 (1), S. 11–23. Online verfügbar unter

Smartphones have become a prevalent technology as they provide employees with instant access to work-related information and communications outside of the office. Despite these advantages, there may be some costs of smartphone use for work at night. Drawing from ego depletion theory, we examined whether smartphone use depletes employees’ regulatory resources and impairs their engagement at work the following day. Across two studies using experience sampling methodology, we found that smartphone use for work at night increased depletion the next morning via its effects on sleep. Morning depletion in turn diminished daily work engagement. The indirect effects of smartphone use on depletion and engagement the next day were incremental to the effects of other electronic devices (e.g., computer, tablet, and television use). We also found some support that the negative effects of morning depletion on daily work engagement may be buffered by job control, such that depletion impairs work engagement only for employees who experience low job control.

Lopez, Richard B.; Hofmann, Wilhelm; Wagner, Dylan D.; Kelley, William M.; Heatherton, Todd F. (2014): Neural Predictors of Giving in to Temptation in Daily Life. In: Psychol Sci. DOI: 10.1177/0956797614531492.

The ability to control desires, whether for food, sex, or drugs, enables people to function successfully within society. Yet, in tempting situations, strong impulses often result in self-control failure. Although many triggers of self-control failure have been identified, the question remains as to why some individuals are more likely than others to give in to temptation. In this study, we combined functional neuroimaging and experience sampling to determine if there are brain markers that predict whether people act on their food desires in daily life. We examined food-cue-related activity in the nucleus accumbens (NAcc), as well as activity associated with response inhibition in the inferior frontal gyrus (IFG). Greater NAcc activity was associated with greater likelihood of self-control failures, whereas IFG activity supported successful resistance to temptations. These findings demonstrate an important role for the neural mechanisms underlying desire and self-control in people’s real-world experiences of temptations.

McClatchley, Kirstie; Shorter, Gillian W.; Chalmers, Jenny (2014): Deconstructing alcohol use on a night out in england: Promotions, preloading and consumption. In: Drug and Alcohol Review. Online verfügbar unter

Abstract Introduction and Aims To examine alcohol consumed during a drinking event (a single drinking occasion) by those attending public house/on‐trade establishments on nights with standard pricing and nights with promotional prices. Design and Methods Data (n = 425) were collected in an ecological momentary assessment over eight nights in two locations (Midlands and London) on both promotional and standard (Saturday) nights. Multiple regression was used to predict event alcohol consumption by sex, age, type of night, alcohol preloading behaviour, marital and employment status, education, Alcohol Use Disorders Identification Test alcohol consumption questions separately or total AUDIT‐C and social group size. Results Mean (UK) units consumed were 11.8 (London) and 14.4 (Midlands). In London, consumption was similar on promotional and standard nights, but in the Midlands, standard night consumption was three units higher. Preloading was reported by 30%; more common on standard nights. Regression analyses revealed being male, preloading and past‐year total AUDIT‐C were associated with higher event consumption. However, when AUDIT‐C questions were added separately, being a standard night was associated with increased event consumption and different AUDIT‐C questions were significantly associated with event consumption in each location. Discussion and Conclusions Event consumption reflected heavy episodic drinking and was influenced by price. Promotional night consumption either matched standard Saturday night consumption or was slightly lower. In London, there was a significant preference for drinking at least one promotional beverage on promotional nights. On standard nights, consumption was over a wider range of venues, and preloading with off‐trade alcohol was more likely. [McClatchley K, Shorter GW, Chalmers J. Deconstructing alcohol use on a night out in England: Promotions, preloading and consumption. Drug Alcohol Rev 2014]

McClure, Erin A.; Gray, Kevin M. (2013): The Remote Monitoring of Smoking in Adolescents. In: Adolesc Psychiatry (Hilversum) 3 (2), S. 156–162. DOI: 10.2174/2210676611303020006.

BACKGROUND/OBJECTIVES: Cigarette smoking remains the leading cause of preventable death in the United States with the vast majority of adult smokers starting prior to the age of 18. Despite the public health relevance and implications of studying smoking in adolescents, little is known about the initiation of quit attempts, the process of relapse, and the most efficacious treatment interventions in this high-risk and underserved population. Issues such as retention in research studies and accuracy of self-reports have prompted investigators to explore innovative technology-based systems to integrate into treatment studies and services delivery. METHODS: This paper will review the remote monitoring of smoking through means of ecological momentary assessment, biochemical verification of smoking verified through video capture, physiological monitoring, and mobile-delivered interventions using self-reported smoking outcomes in adolescents, when applicable. RESULTS: Use of remote monitoring methods in adolescent smokers has been limited thus far, though monitoring technology in adults has shown promise for understanding relapse and delivering treatment interventions. CONCLUSIONS: Comprehensive technology-based systems that do not rely primarily on self-report to monitor smoking would be a highly fruitful and innovative avenue to explore with adolescent smokers. Technology integration holds great promise to improve health-related research, treatment delivery, cost-effectiveness, and just-in-time interventions, but its novelty comes with unique problems and concerns to be carefully considered.

McMinn, David; Oreskovic, Nicolas M.; Aitkenhead, Matt J.; Johnston, Derek W.; Murtagh, Shemane; Rowe, David A. (2014): The physical environment and health-enhancing activity during the school commute: global positioning system, geographical information systems and accelerometry. In: Geospat Health 8 (2), S. 569–572.

Active school travel is in decline. An understanding of the potential determinants of health-enhancing physical activity during the school commute may help to inform interventions aimed at reversing these trends. The purpose of this study was to identify the physical environmental factors associated with health-enhancing physical activity during the school commute. Data were collected in 2009 on 166 children commuting home from school in Scotland. Data on location and physical activity were measured using global positioning systems (GPS) and accelerometers, and mapped using geographical information systems (GIS). Multi-level logistic regression models accounting for repeated observations within participants were used to test for associations between each land-use category (road/track/path, other man-made, greenspace, other natural) and moderate-to-vigorous physical activity (MVPA). Thirty-nine children provided 2,782 matched data points. Over one third (37.1%) of children’s school commute time was spent in MVPA. Children commuted approximately equal amounts of time via natural and man-made land-uses (50.2% and 49.8% respectively). Commuting via road/track/path was associated with increased likelihood of MVPA (Exp(B)=1.23, P <0.05), but this association was not seen for commuting via other manmade land-uses. No association was noted between greenspace use and MVPA, but travelling via other natural land-uses was associated with lower odds of MVPA (Exp(B)=0.32, P <0.05). Children spend equal amounts of time commuting to school via man-made and natural land-uses, yet man-made transportation route infrastructure appears to provide greater opportunities for achieving health-enhancing physical activity levels.

Mimura, Koki; Kishino, Hirohisa; Karino, Genta; Nitta, Etsuko; Senoo, Aya; Ikegami, Kentaro et al. (2014): Potential of a smartphone as a stress-free sensor of daily human behaviour. In: Behav Brain Res. DOI: 10.1016/j.bbr.2014.06.007.

Behaviour is one of the most powerful objective signals that connotes psychological functions regulated by neuronal network systems. This study searched for simple behaviours using smartphone sensors with three axes for measuring acceleration, angular speed and direction. We used quantitative analytic methodology of pattern recognition for work contexts, individual workers and seasonal effects in our own longitudinally recorded data. Our 13 laboratory members were involved in the care of common marmosets and domestic chicks, which lived in separate rooms. They attached a smartphone to their front waist-belts during feeding and cleaning in five care tasks. Behavioural characteristics such as speed, acceleration and azimuth, pitch, and roll angles were monitored. Afterwards, participants noted subjective scores of warmth sensation and work efficiency. The multivariate time series data were characterized by the subjective scores and environmental factors such as room temperature, season, and humidity, using the linear mixed model. In contrast to high-precision but stress-inducing sensors, the mobile sensors measuring daily behaviours allowed us to quantify the effects of the psychological states and environmental factors on the behavioural traits.

Min, Yul Ha; Lee, Jong Won; Shin, Yong-Wook; Jo, Min-Woo; Sohn, Guiyun; Lee, Jae-Ho et al. (2014): Daily collection of self-reporting sleep disturbance data via a smartphone app in breast cancer patients receiving chemotherapy: a feasibility study. In: J Med Internet Res 16 (5), S. e135. DOI: 10.2196/jmir.3421.

BACKGROUND: Improvements in mobile telecommunication technologies have enabled clinicians to collect patient-reported outcome (PRO) data more frequently, but there is as yet limited evidence regarding the frequency with which PRO data can be collected via smartphone applications (apps) in breast cancer patients receiving chemotherapy. OBJECTIVE: The primary objective of this study was to determine the feasibility of an app for sleep disturbance-related data collection from breast cancer patients receiving chemotherapy. A secondary objective was to identify the variables associated with better compliance in order to identify the optimal subgroups to include in future studies of smartphone-based interventions. METHODS: Between March 2013 and July 2013, patients who planned to receive neoadjuvant chemotherapy for breast cancer at Asan Medical Center who had access to a smartphone app were enrolled just before the start of their chemotherapy and asked to self-report their sleep patterns, anxiety severity, and mood status via a smartphone app on a daily basis during the 90-day study period. Push notifications were sent to participants daily at 9 am and 7 pm. Data regarding the patients’ demographics, interval from enrollment to first self-report, baseline Beck’s Depression Inventory (BDI) score, and health-related quality of life score (as assessed using the EuroQol Five Dimensional [EQ5D-3L] questionnaire) were collected to ascertain the factors associated with compliance with the self-reporting process. RESULTS: A total of 30 participants (mean age 45 years, SD 6; range 35-65 years) were analyzed in this study. In total, 2700 daily push notifications were sent to these 30 participants over the 90-day study period via their smartphones, resulting in the collection of 1215 self-reporting sleep-disturbance data items (overall compliance rate=45.0%, 1215/2700). The median value of individual patient-level reporting rates was 41.1% (range 6.7-95.6%). The longitudinal day-level compliance curve fell to 50.0% at day 34 and reached a nadir of 13.3% at day 90. The cumulative longitudinal compliance curve exhibited a steady decrease by about 50% at day 70 and continued to fall to 45% on day 90. Women without any form of employment exhibited the higher compliance rate. There was no association between any of the other patient characteristics (ie, demographics, and BDI and EQ5D-3L scores) and compliance. The mean individual patient-level reporting rate was higher for the subgroup with a 1-day lag time, defined as starting to self-report on the day immediately after enrollment, than for those with a lag of 2 or more days (51.6%, SD 24.0 and 29.6%, SD 25.3, respectively; P=.03). CONCLUSIONS: The 90-day longitudinal collection of daily self-reporting sleep-disturbance data via a smartphone app was found to be feasible. Further research should focus on how to sustain compliance with this self-reporting for a longer time and select subpopulations with higher rates of compliance for mobile health care.

Minami, Haruka; Yeh, Vivian M.; Bold, Krysten W.; Chapman, Gretchen B.; McCarthy, Danielle E. (2014): Relations among affect, abstinence motivation and confidence, and daily smoking lapse risk. In: Psychol Addict Behav 28 (2), S. 376–388. DOI: 10.1037/a0034445.

This study tested the hypothesis that changes in momentary affect, abstinence motivation, and confidence would predict lapse risk over the next 12-24 hr using Ecological Momentary Assessment (EMA) data from smokers attempting to quit smoking. One hundred and three adult, daily, treatment-seeking smokers recorded their momentary affect, motivation to quit, abstinence confidence, and smoking behaviors in near real time with multiple EMA reports per day using electronic diaries postquit. Multilevel models indicated that initial levels of negative affect were associated with smoking, even after controlling for earlier smoking status, and that short-term increases in negative affect predicted lapses up to 12, but not 24, hr later. Positive affect had significant effects on subsequent abstinence confidence, but not motivation to quit. High levels of motivation appeared to reduce increases in lapse risk that occur over hours although momentary changes in confidence did not predict lapse risk over 12 hr. Negative affect had short-lived effects on lapse risk, whereas higher levels of motivation protected against the risk of lapsing that accumulates over hours. An increase in positive affect was associated with greater confidence to quit, but such changes in confidence did not reduce short-term lapse risk, contrary to expectations. Relations observed among affect, cognitions, and lapse seem to depend critically on the timing of assessments.

Mitchell, John T.; Dennis, Michelle F.; English, Joseph S.; Dennis, Paul A.; Brightwood, Amy; Beckham, Jean C.; Kollins, Scott H. (2014): Ecological Momentary Assessment of Antecedents and Consequences of Smoking in Adults with Attention-Deficit/Hyperactivity Disorder. In: Subst Use Misuse. DOI: 10.3109/10826084.2014.912229.

The current study assessed antecedents and consequences of ad lib cigarette smoking in smokers diagnosed with attention-deficit/hyperactivity disorder (ADHD) using ecological momentary assessment (EMA). Adult smokers with ADHD (n = 17) completed 870 smoking and 622 nonsmoking electronic diary entries over a 7-day observation period of their naturalistic smoking behavior. Data collection occurred from 2011 to 2012. Generalized estimating equations indicated that ADHD smokers were more likely to smoke when urge to smoke, negative affect, boredom, stress, worry, and restlessness were elevated. In addition, participants were more likely to smoke in situations that elicited higher levels of nervousness and frustration. ADHD symptoms, in general, did not differ between smoking and nonsmoking contexts, though hyperactive-impulsive ADHD symptoms were elevated prior to smoking in frustrating situations. Additional situational antecedent variables were associated with smoking, including being in the presence of others smoking, being in a bar or restaurant, while outside, and while consuming caffeinated or alcoholic beverages. Participants also reported a significant improvement in urge to smoke, negative affect, stress, hunger, and ADHD symptoms after smoking a cigarette. Findings suggest certain contextual factors that may maintain ad lib cigarette smoking in smokers with ADHD and identify potential treatment targets in smoking cessation interventions for this at-risk group. Clinical implications and future research directions are discussed. Funding for this study was provided by the National Institute on Drug Abuse.

Mitchell, John T.; Schick, Robert S.; Hallyburton, Matt; Dennis, Michelle F.; Kollins, Scott H.; Beckham, Jean C.; McClernon, F. Joseph (2014): Combined Ecological Momentary Assessment and Global Positioning System Tracking to Assess Smoking Behavior: A Proof of Concept Study. In: J Dual Diagn 10 (1), S. 19–29. DOI: 10.1080/15504263.2013.866841.

OBJECTIVE: Ecological momentary assessment (EMA) methods have provided a rich assessment of the contextual factors associated with a wide range of behaviors including alcohol use, eating, physical activity, and smoking. Despite this rich database, this information has not been linked to specific locations in space. Such location information, which can now be easily acquired from global positioning system (GPS) tracking devices, could provide unique information regarding the space-time distribution of behaviors and new insights into their determinants. In a proof of concept study, we assessed the acceptability and feasibility of acquiring and combining EMA and GPS data from adult smokers with attention deficit hyperactivity disorder (ADHD). METHODS: Participants were adults with ADHD who were enrolled in a larger EMA study on smoking and psychiatric symptoms. Among those enrolled in the latter study who were approached to participate (N = 11), 10 consented, provided daily EMA entries, and carried a GPS device with them during a 7-day assessment period to assess aspects of their smoking behavior. RESULTS: The majority of those eligible to participate were willing to carry a GPS device and signed the consent (10 out of 11, 91%). Of the 10 who consented, 7 participants provided EMA entries and carried the GPS device with them daily for at least 70% of the sampling period. Data are presented on the spatial distribution of smoking episodes and ADHD symptoms on a subset of the sample to demonstrate applications of GPS data. CONCLUSIONS: We conclude by discussing how EMA and GPS might be used to study the ecology of smoking and make recommendations for future research and analysis.

Moore, Todd M.; Seavey, Amanda; Ritter, Kathrin; McNulty, James K.; Gordon, Kristina C.; Stuart, Gregory L. (2014): Ecological momentary assessment of the effects of craving and affect on risk for relapse during substance abuse treatment. In: Psychology of Addictive Behaviors 28 (2), S. 619–624. DOI: 10.1037/t01528-000;

The primary goals of this study were to use ecological momentary assessment (EMA) to examine the extent to which proximal factors (cravings and affect) were temporally associated with relapse, and to assess the role of distal factors (e.g., coping styles) in moderating these associations. We also examined whether using EMA procedures impacted relapse rates. A sample of 100 male (n = 66) and female (n = 34) patients entering outpatient treatment for substance abuse completed a baseline assessment of substance dependence, stress, social support, coping styles, family history of substance abuse, and self-efficacy. Half of the participants were randomly assigned to receive training in using a handheld computer to respond to 3 random prompts each day for 4 months regarding cravings, affect, and substance use. All participants completed 2- and 4-month follow-up assessments of substance use. Results showed that using EMA procedures did not influence relapse rates. Hierarchical linear modeling showed that individuals who reported an increase in cravings on a given prompt were 14 times more likely to report relapse on the subsequent prompt than individuals who did not experience an increase in cravings. In addition, women, older individuals, and individuals who use distraction and disengagement as coping styles were at increased risk for relapse when experiencing an increase in cravings. Individuals who use acceptance as a coping style were at decreased risk for relapse when experiencing an increase in cravings. The study highlights the importance of tailoring treatments to address the needs of particular individuals and risk factors.

Nedios, Sotirios; Romero, Inaki; Gerds-Li, Jin-Hong; Fleck, Eckard; Kriatselis, Charalampos (2014): Precordial electrode placement for optimal ECG monitoring: Implications for ambulatory monitor devices and event recorders. In: J Electrocardiol. DOI: 10.1016/j.jelectrocard.2014.04.003.

INTRODUCTION: Detection of QRS complexes, P-waves and atrial fibrillation f-waves in electrocardiographic (ECG) signals is critical for the correct diagnosis of arrhythmias. We aimed to find the best bipolar lead (BL) with the highest signal amplitude and shortest inter-electrode spacing. METHODS: ECG signals (120seconds) were recorded in 36 patients with 16 precordial electrodes placed in a standardized pattern. An average signal was analysed for each of 120 possible BLs obtained by calculating the difference between pairs of unipolar leads. Peak-to-peak amplitudes of QRS waves (50ms around R-peak) and P waves (270-70ms before R-peak) were calculated. For patients with atrial fibrillation, power of the fibrillatory (f) wave was used instead. Maximum values at each distance were considered and differentiation analysis was performed based on incremental changes (amplitude to distance). RESULTS: There was a significant correlation between distance and QRS-amplitude (r=0.78, p<0.001), P-wave amplitude (r=0.60, p<0.01) and f-wave power (r=0.79, p<0.001). The range of values was: QRS-amplitude 0.7-2.33mV, P-wave amplitude 0.07-0.18mV, and f-wave power 0.55-2.12mV2/s. The maximum value for the shortest distance was on a heart-aligned axis over the left ventricle for the QRS complex (1.9mV at 8.7cm) and over the atria for the P-wave (0.98mV) and f-waves (1.45mV2/s at 8cm, respectively). CONCLUSION: There is a strong positive correlation between electrode distance and ECG signal-amplitude. Distance of 8cm on a heart-aligned axis and over the relevant heart-chamber provides the highest signal amplitude for the shortest distance. These findings are essential for the design and use of ambulatory monitoring devices.

Niiranen, Teemu J.; Maki, Juhani; Puukka, Pauli; Karanko, Hannu; Jula, Antti M. (2014): Office, Home, and Ambulatory Blood Pressures as Predictors of Cardiovascular Risk. In: Hypertension. DOI: 10.1161/HYPERTENSIONAHA.114.03292.

Ambulatory blood pressure (BP) is considered as the gold standard of BP measurement although it has not been shown to be more strongly associated with cardiovascular risk than is home BP. Our objective was to compare the prognostic value of office, home, and ambulatory BP for cardiovascular risk in 502 participants examined in 1992 to 1996. The end point was a composite of cardiovascular mortality, myocardial infarction, stroke, heart failure hospitalization, and coronary intervention. We assessed the prognostic value of each BP in multivariable-adjusted Cox models. The likelihood chi2 ratio value was used to test whether the addition of a BP variable improved the model’s goodness of fit. After a follow-up of 16.1+/-3.9 years, 70 participants (13.9%) had experienced >/=1 cardiovascular event. Office (systolic/diastolic hazard ratio per 1/1 mm Hg increase in BP, 1.024/1.018; systolic/diastolic 95% confidence interval, 1.009-1.040/0.994-1.043), home (hazard ratio, 1.029/1.028; 95% confidence interval, 1.013-1.045/1.005-1.052), and 24-hour ambulatory BP (hazard ratio, 1.033/1.049; 95% confidence interval, 1.019-1.047/1.023-1.077) were predictive of cardiovascular events. When all 3 BP variables were included in the model simultaneously, only systolic/diastolic ambulatory BP was a significant predictor of cardiovascular events (P=0.002/<0.001). Home systolic/diastolic BP improved the fit of the model only marginally when added to a model including office BP (chi2=3.0/4.0, P=0.09/0.047). Ambulatory BP, however, improved the fit of model more clearly when added to office and home BP (chi2=9.0/12.3, P=0.001/<0.001). Our findings suggest that ambulatory BP is prognostically superior to office and home BP.

Offer, Shira (2014): Time with children and employed parents’ emotional well-being. In: Soc Sci Res 47, S. 192–203. DOI: 10.1016/j.ssresearch.2014.05.003.

Using the experience sampling method and survey data from the 500 Family Study this study examined how parents feel when they spend time with their children and whether their emotional experiences differ by type of activity and the parent’s gender. I found that mothers spent more time in childcare than fathers but this disparity was primarily due to mothers’ more frequent engagement in activities that were not child-centered (i.e., non-focused and passive childcare). Multilevel models further showed that engagement in these activities was related to higher positive affect. Shared meals and leisure activities were particularly beneficial to parents’ emotional well-being and the likelihood of engaging in them was not affected by parents’ paid work hours. By contrast, routine childcare was associated with increased stress and lower engagement but only among mothers. Mothers were also less likely to provide childcare in conjunction with their spouse. These findings reveal the subtle dimensions of the unequal division of childcare by gender.

Phillips, Michael M.; Phillips, Kristina T.; Lalonde, Trent L.; Dykema, Kristy R. (2014): Feasibility of text messaging for ecological momentary assessment of marijuana use in college students. In: Psychol Assess. DOI: 10.1037/a0036612.

Measuring self-reported substance use behavior is challenging due to issues related to memory recall and patterns of bias in estimating behavior. Limited research has focused on the use of ecological momentary assessment (EMA) to evaluate marijuana use. This study assessed the feasibility of using short message service (SMS) texting as a method of EMA with college-age marijuana users. Our goals were to evaluate overall response/compliance rates and trends of data missingness, response time, baseline measures (e.g., problematic use) associated with compliance rates and response times, and differences between EMA responses of marijuana use compared to timeline followback (TLFB) recall. Nine questions were texted to participants on their personal cell phones 3 times a day over a 2-week period. Overall response rate was high (89%). When examining predictors of the probability of data missingness with a hierarchical logistic regression model, we found evidence of a higher propensity for missingness for Week 2 of the study compared to Week 1. Self-regulated learning was significantly associated with an increase in mean response time. A model fit at the participant level to explore response time found that more time spent smoking marijuana related to higher response times, while more time spent studying and greater “in the moment” academic motivation and craving were associated with lower response times. Significant differences were found between the TLFB and EMA, with greater reports of marijuana use reported through EMA. Overall, results support the feasibility of using SMS text messaging as an EMA method for college-age marijuana users.

Piasecki, Thomas M.; Cooper, M. Lynne; Wood, Phillip K.; Sher, Kenneth J.; Shiffman, Saul; Heath, Andrew C. (2014): Dispositional drinking motives: Associations with appraised alcohol effects and alcohol consumption in an ecological momentary assessment investigation. In: Psychological Assessment 26 (2), S. 363–369. Online verfügbar unter

Alcohol use can be understood as a strategic behavior, such that people choose to drink based on the anticipated affective changes produced by drinking relative to those produced by alternative behaviors. This study investigated whether people who report drinking for specific reasons via the Drinking Motives Questionnaire–Revised (DMQ-R; Cooper, 1994) actually experience the alcohol effects they purportedly seek. As a secondary goal, we examined relations between drinking motives and indices of the amount of alcohol consumed. Data were drawn from 3,272 drinking episodes logged by 393 community-recruited drinkers during a 21-day Ecological Momentary Assessment investigation. After accounting for selected covariates, DMQ-R enhancement motives uniquely predicted real-time reports of enhanced drinking pleasure. DMQ-R coping motives were associated with reports of increased drinking-contingent relief and punishment. Enhancement motives uniquely predicted consuming more drinks per episode and higher peak intra-episode estimated blood alcohol concentration. The findings extend the evidence for the validity of the DMQ-R motive scores by demonstrating that internal drinking motives (enhancement and coping) are related to the experienced outcomes of drinking in the manner anticipated by theory.

Pishva, Ehsan; Drukker, Marjan; Viechtbauer, Wolfgang; Decoster, Jeroen; Collip, Dina; van Winkel, Ruud et al. (2014): Epigenetic genes and emotional reactivity to daily life events: a multi-step gene-environment interaction study. In: PLoS One 9 (6), S. e100935. DOI: 10.1371/journal.pone.0100935.

Recent human and animal studies suggest that epigenetic mechanisms mediate the impact of environment on development of mental disorders. Therefore, we hypothesized that polymorphisms in epigenetic-regulatory genes impact stress-induced emotional changes. A multi-step, multi-sample gene-environment interaction analysis was conducted to test whether 31 single nucleotide polymorphisms (SNPs) in epigenetic-regulatory genes, i.e. three DNA methyltransferase genes DNMT1, DNMT3A, DNMT3B, and methylenetetrahydrofolate reductase (MTHFR), moderate emotional responses to stressful and pleasant stimuli in daily life as measured by Experience Sampling Methodology (ESM). In the first step, main and interactive effects were tested in a sample of 112 healthy individuals. Significant associations in this discovery sample were then investigated in a population-based sample of 434 individuals for replication. SNPs showing significant effects in both the discovery and replication samples were subsequently tested in three other samples of: (i) 85 unaffected siblings of patients with psychosis, (ii) 110 patients with psychotic disorders, and iii) 126 patients with a history of major depressive disorder. Multilevel linear regression analyses showed no significant association between SNPs and negative affect or positive affect. No SNPs moderated the effect of pleasant stimuli on positive affect. Three SNPs of DNMT3A (rs11683424, rs1465764, rs1465825) and 1 SNP of MTHFR (rs1801131) moderated the effect of stressful events on negative affect. Only rs11683424 of DNMT3A showed consistent directions of effect in the majority of the 5 samples. These data provide the first evidence that emotional responses to daily life stressors may be moderated by genetic variation in the genes involved in the epigenetic machinery.

Raj, Rishi; Ussavarungsi, Kamonpun; Nugent, Kenneth (2014): Accelerometer-based devices can be used to monitor sedation/agitation in the intensive care unit. In: J Crit Care. DOI: 10.1016/j.jcrc.2014.05.014.

PURPOSE: Monitoring sedation/agitation levels in patients in the intensive care unit (ICU) are important to direct treatment and to improve outcomes. This study was designed to determine the potential use of accelerometer-based sensors/devices to objectively measure sedation/agitation in patients admitted to the ICU. MATERIALS AND METHODS: Accelerometer-based devices (actigraphs) were placed on nondominant wrists of 86 patients in the ICU after informed consent. The sedation/agitation levels were classified as deep sedation, light sedation, alert and calm, mild agitation and severe agitation, and measured at regular intervals. The sedation/agitation levels were correlated with the accelerometer data (downloaded raw actigraphy data). RESULTS: The sedation/agitation levels correlated strongly with the accelerometer readings represented by mean actigraphy counts (r = 0.968; P = .007) and the proportion of time spent moving as determined by actigraphy (r = 0.979; P = .004). CONCLUSIONS: Accelerometer data correlate strongly with the sedation/agitation levels of patients in the ICUs, and appropriately designed accelerometer-based sensors/devices have the potential to be used for automating objective and continuous monitoring of sedation/agitation levels in patients in the ICU.

Ratcliff, Chelsea G.; Lam, Cho Y.; Arun, Banu; Valero, Vincente; Cohen, Lorenzo (2014): Ecological momentary assessment of sleep, symptoms, and mood during chemotherapy for breast cancer. In: Psychooncology. DOI: 10.1002/pon.3525.

OBJECTIVE: This study examined the association of sleep before and during a chemotherapy (CT) cycle for breast cancer with symptoms and mood during a CT cycle. METHODS: Twenty women undergoing CT for breast cancer completed the Pittsburgh Sleep Quality Index (PSQI) 1 h prior to a CT infusion. For 3 weeks following infusion, participants estimated sleep efficiency, minutes to sleep (sleep latency), number of nocturnal awakenings (sleep fragmentation (SF)), and sleep quality (SQ) each morning and rated symptoms (nausea, fatigue, numbness, and difficulty thinking) and mood three times daily (morning, afternoon, and evening) via ecological momentary assessments using automated handheld computers. RESULTS: The results showed that disturbed sleep (PSQI score > 5) prior to CT infusion was associated with greater fatigue, and more negative and anxious mood throughout the 3-week CT cycle, and good pre-CT infusion sleep (PSQI score < 5) buffered anxious mood in the first days following infusion. Time-lagged analyses controlling for mood/symptom ratings reported the previous evening revealed that longer sleep latency and greater SF were associated with greater daytime fatigue; poorer SQ and greater SF were antecedents of worse morning negative mood, and greater SF was associated with feeling more passive and drowsy. No evening symptom or mood ratings were related to subsequent SQ. CONCLUSIONS: These findings suggest that disturbed sleep before and after a CT infusion exacerbates fatigue, and negative, anxious, and drowsy mood during a CT cycle. Reducing sleep disturbance may be an important way to improve quality of life during CT. Copyright (c) 2014 John Wiley & Sons, Ltd.

Ratcliff, Megan B.; Zeller, Meg H.; Inge, Thomas H.; Hrovat, Kathleen B.; Modi, Avani C. (2014): Feasibility of ecological momentary assessment to characterize adolescent postoperative diet and activity patterns after weight loss surgery. In: Surg Obes Relat Dis. DOI: 10.1016/j.soard.2014.01.034.

BACKGROUND: Adherence to postoperative lifestyle recommendations may be associated with weight outcomes among weight loss surgery (WLS) patients, but it is difficult to objectively assess and has not been reported among adolescents. Methods of assessment that are ecologically valid and provide important contextual information related to adherence are needed. The objective of this pilot study was to demonstrate the feasibility of using a form of ecological momentary assessment (i.e., daily phone diaries; DPD) to assess postoperative diet and activity patterns among a sample of adolescent WLS patients to determine adherence to best-practice lifestyle recommendations. SETTING: University Hospital. METHODS: Eight adolescent WLS patients completed 3 consecutive DPDs at 12 and 18 months postsurgery. RESULTS: Ninety-four percent of DPD’s were completed with an average 20.9+/-5.0 activities/day. Although adolescents engaged in recommended lifestyle behaviors (e.g.,>/=30 min moderate physical activity/d; duration of meals/snacks>/=20 min) some of the time, few were adherent to postoperative physical activity and dietary recommendations the majority of the time. CONCLUSION: The DPD provides a feasible and informative methodology for assessing adherence behaviors among adolescent WLS patients. It is a relatively low burden method that may be useful in identifying behavioral targets for postoperative intervention. Adherence to postoperative lifestyle recommendations may be a serious concern among this cohort. These preliminary data shed light on potential targets for postoperative intervention. Targeting nonadherence is essential in not only improving health outcomes but in deciphering the true potential effectiveness of WLS in this at-risk population.

Robbins, Megan L.; López, Ana María; Weihs, Karen L.; Mehl, Matthias R. (2014): Cancer conversations in context: Naturalistic observation of couples coping with breast cancer. In: Journal of Family Psychology 28 (3), S. 380–390. DOI: 10.1037/t02175-000;

This study explored the feasibility and potentials of a naturalistic observation approach to studying dyadic coping in everyday life. Specifically, it examined the natural context and content of the spontaneous cancer conversations of couples coping with cancer, and how they relate to patients’ and spouses’ psychological adjustment. Women with breast cancer (N = 56) and their spouses wore the electronically activated recorder (EAR), an unobtrusive observation method that periodically records snippets of ambient sounds, over one weekend to observe the couples’ cancer conversations in their natural context. Both patients and spouses completed self-reported measures of psychological adjustment at baseline and at a 2-month follow-up. Cancer was a topic of approximately 5% of couples’ conversations. Cancer conversations occurred more often within the couple than with friends and family, and they were more often informational than emotional or supportive. Consistent with research on the social cognitive processing model (Lepore & Revenson, 2007), spouses’ engagement in emotional disclosure and informational conversation with patients predicted better patient adjustment. This first naturalistic observation study of dyadic coping revealed that the EAR method can be implemented with high compliance and relatively low obtrusiveness within the sensitive context of couples coping with cancer, and having a spouse who discussed cancer in an emotional or informational way predicted better patient adjustment. As a complement to in-lab and other momentary assessment methods, a naturalistic observation approach with a method such as the EAR can contribute to a more comprehensive understanding of the role that communication processes play in coping with cancer.

Robustillo Cortes, Maria de Las Aguas; Cantudo Cuenca, Maria Rosa; Morillo Verdugo, Ramon; Calvo Cidoncha, Elena (2014): High Quantity but Limited Quality in Healthcare Applications Intended for HIV-Infected Patients. In: Telemed J E Health. DOI: 10.1089/tmj.2013.0262.

Abstract Objective: The aim of this study was to evaluate, through the creation of a specific questionnaire, the information quality in mobile applicatons (apps) aimed at human immunodeficiency virus (HIV)-infected patients. We also established a quality rating and identified the main strengths and weaknesses of this kind of health app. Materials and Methods: Smartphone apps specifically related to HIV/acquired immunodeficiency syndrome (AIDS) were searched. We conducted a key word search with the terms “HIV,” “AIDS,” and “acquired immune deficiency syndrome” in the Apple (Cupertino, CA) App Store and the Android Google (Mountain View, CA) Play Store. A questionnaire was developed based on the different quality recommendations for health apps up to December 2012. The recommendations consulted were as follows: the Happtique Health App Certification Program, the Food and Drug Administration (Mobile Medical Applications), and recommendations for the design, use, and evaluation of health apps of the Agency of Health Quality in Andalusia. A group of 17 experts assessed the importance of the different sections by using a Delphi method. Results: In total, 41 health apps were analyzed. Only one app (2.4%), called inPractice HIV, approached class A. The remaining were classed as follows: 2 (4.9%) class B, 1 (2.4%) class C, 5 (12.2%) class D and E, and 27 (65.9%) class F (not exceeding minimum criteria). The design and the relevance were highlighted among the strengths. The main areas for improvement are provision of services and confidentiality in addition to privacy policies. Conclusions: The quality of the revised apps is limited. Only one app complied with the excellence criteria, and over 50% of the apps did not exceed minimum quality standards. The worst rated aspects were political advertising and logical security.

Rowlands, Alex V.; Fraysse, Francois; Catt, Mike; Stiles, Victoria H.; Stanley, Rebecca M.; Eston, Roger G.; Olds, Tim S. (2014): Comparability of Measured Acceleration from Accelerometry-Based Activity Monitors. In: Med Sci Sports Exerc. DOI: 10.1249/MSS.0000000000000394.

BACKGROUND: Accelerometers that provide triaxial measured acceleration data are now available. However, equivalence of output between brands cannot be assumed and testing is necessary to determine whether features of the acceleration signal are interchangeable. PURPOSE: To establish the equivalence of output between two brands of monitor in a laboratory and in a free-living environment. METHODS: Part 1: Thirty-eight adults performed nine laboratory-based activities while wearing an ActiGraph GT3X+ and GENEActiv at the hip. Part 2: Fifty-eight 10-12 y old children wore a GT3X+ and GENEActiv at the hip for seven days in a free-living setting. RESULTS: Part 1: The magnitude of time-domain features from the GENEActiv was greater than from the GT3X+. However, frequency domain features compared well, with perfect agreement of the dominant frequency for 97-100% of participants for most activities. Part 2: Mean daily acceleration measured by the two brands was correlated (r=0.93, p<0.001, respectively), but the magnitude was ~15% lower for the GT3X+ than the GENEActiv at the hip. CONCLUSION: Frequency-domain-based classification algorithms should be transferable between monitors and it should be possible to apply time-domain-based classification algorithms developed for one device to the other, by applying an affine conversion on the measured acceleration values. The strong relationship between accelerations measured by the two brands suggests habitual activity level and activity patterns assessed by the GENE and GT3X+ may compare well if analysed appropriately.

Sartori, Raffaela D. G.; Marelli, Marco; Garavaglia, Paolo; Castelli, Lucia; Busin, Silvano; Delle Fave, Antonella (2014): The Assessment of Patients’ Quality of Experience: Autonomy Level and Perceived Challenges. In: Rehabilitation Psychology. Online verfügbar unter

Purpose/Objective: Motor rehabilitation programs in hospital aim at promoting patients’ highest attainable recovery of body functions and capabilities. Well-being is predominantly identified with physical autonomy, yet the psychological dimensions of rehabilitation are often overlooked. Research Method/Design: To partially fill this gap, the quality of daily experience reported by 50 adult participants hospitalized in an Italian rehabilitation unit was investigated. Data were gathered through Experience Sampling Method, (ESM), providing repeated real-time assessments of the experience associated with daily activities. Before analysis, participants were divided into 3 groups, according to their low, moderate, or high levels of autonomy assessed through Barthel Index. Results: Participants predominantly associated rehabilitation activities with optimal experience, characterized by high concentration, engagement, control of the situation, and by the perception of high challenges matched with adequate personal skills. During personal care and leisure—the most frequent daily activities—participants reported instead low challenging experiences of apathy and boredom. During social interactions perceived high challenges prevailed. Multilevel analysis showed that the type of activity performed was a significant predictor of participants’ quality of experience, and the level of autonomy had a modest impact on it. Conclusions/Implications: Results highlighted the potential added value of rehabilitation tasks as opportunities to promote patients’ well-being. The predominantly negative experiences associated with the other daily activities point instead to the need for changes in hospital organization in order to more effectively promote patients’ autonomy and resource mobilization.

Schwerdtfeger, Andreas R.; Gerteis, Ann Kathrin S. (2014): The manifold effects of positive affect on heart rate variability in everyday life: Distinguishing within-person and between-person associations. In: Health Psychology. Online verfügbar unter

Objective: Positive affect (PA) has been related to better health. However, the biological pathways underlying this link are not well understood. Different facets of PA (e.g., low activated vs. high activated) and both state and trait PA might have different effects on physiology. Method: This study aimed to relate low- and high-activated facets of momentary assessed (i.e., state) and aggregated (i.e., trait-like) PA to cardiac vagal tone (heart rate variability; HRV) in everyday life (N = 122, with 3 successive recording days). Results: Aggregated activated PA was associated with higher ambulatory HRV, whereas activated momentary PA was accompanied by lower HRV. Moreover, momentary deactivated PA was accompanied by higher HRV, but aggregated deactivated PA was not. Findings were independent of negative affect and various other demographic and behavioral confounds. Conclusions: Together the findings suggest a more complex picture of the health-related effects of PA. Whereas state-related fluctuations in PA seem to exert both activating and deactivating effects on the heart, activated PA on an aggregated level seems to dampen cardiac arousal, thus suggesting beneficial effects for health.

Schwerdtfeger, Andreas R.; Schienle, Anne; Leutgeb, Verena; Rathner, Eva-Maria (2014): Does cardiac reactivity in the laboratory predict ambulatory heart rate? Baseline counts. In: Psychophysiology 51 (6), S. 565–572. DOI: 10.1111/psyp.12199.

Cardiovascular reactivity to laboratory stress might predict cardiovascular load in everyday life. However, previous research throws doubt on this hypothesis. This study examined associations between heart rate (HR) to a public speaking task and ambulatory HR throughout a day. Electrocardiogram, bodily movement, and psychosocial variables (affect, context) were recorded in 111 individuals. Ambulatory HR was positively associated with both positive and negative affect. Baseline HR in the laboratory significantly predicted ambulatory HR, but HR reactivity did not. The interaction of momentary negative affect and cardiac reactivity in the laboratory was also not significant. However, a significant interaction of baseline HR and reactivity indicated that, when baseline was high, there was a positive relation between HR reactivity and ambulatory HR. Findings suggest that baseline has to be considered when aiming to predict cardiovascular load in everyday life.

Seeger, Christian; van Laerhoven, Kristof; Buchmann, Alejandro (2014): MyHealthAssistant: An Event-driven Middleware for Multiple Medical Applications on a Smartphone-mediated Body Sensor Network. In: IEEE J Biomed Health Inform. DOI: 10.1109/JBHI.2014.2326604.

An ever-growing range of wireless sensors for medical monitoring has shown that there is significant interest in monitoring patients in their everyday surroundings. It however remains a challenge to merge information from several wireless sensors and applications are commonly built from scratch. This paper presents a middleware targeted for medical applications on smartphone-like platforms that relies on an event-based design to enable flexible coupling with changing sets of wireless sensor units, while posing only a minor overhead on the resources and battery capacity of the interconnected devices. We illustrate the requirements for such middleware with three different healthcare applications that were deployed with our middleware solution, and characterize the performance with energy consumption, overhead caused for the smartphone, and processing time under real-world circumstances. Results show that with sensingintensive applications our solution only minimally impacts the phone’s resources, with an added CPU utilization of 3% and a memory usage under 7 MB. Furthermore, for a minimum message delivery ratio of 99.9%, up to 12 sensor readings per second are guaranteed to be handled, regardless of the number of applications using our middleware.

Setodji, Claude M.; Martino, Steven C.; Scharf, Deborah M.; Shadel, William G. (2014): Quantifying the persistence of pro-smoking media effects on college students’ smoking risk. In: Journal of Adolescent Health 54 (4), S. 474–480. Online verfügbar unter

Purpose: To quantify the persistence of pro-smoking media exposure effects on college students’ intentions to smoke and smoking refusal self-efficacy. Method: A total of 134 college students (ages 18–24 years) were enrolled in an ecological momentary assessment study in which they carried handheld data collection devices for 3 weeks and reported their exposures to pro-smoking media as they occurred in the real world. Smoking intentions and smoking refusal self-efficacy were assessed after each exposure to pro-smoking media and at random prompts during each day of the 3-week assessment period. A generalized additive model was used to determine how long the effect of an exposure to pro-smoking media persisted. Results: The effect of pro-smoking media exposures persisted for 7 days. After exposure, smoking intentions immediately increased (.56; 95% confidence interval [CI]: [.26, .87]) and then steadily decreased (−.12; 95% CI: [−.19, −.05]) each day for 7 days, while smoking refusal self-efficacy immediately decreased (−.42; 95% CI: [−.75, −.10]) and then steadily increased (.09; 95% CI: [.02, .16]) each day for 7 days. Daily changes occurring after 7 days were not statistically significant, suggesting that smoking intentions and refusal self-efficacy had stabilized and were no longer affected by pro-smoking media exposure. Conclusions: Exposures to pro-smoking media may have strong implications for emerging young adults smoking risk as the impact of an individual exposure appears to persist for at least a week.

Shelton, Nicole; Douglass, Sara; Garcia, Randi L.; Yip, Tiffany; Trail, Thomas E. (2014): Feeling (Mis)Understood and Intergroup Friendships in Interracial Interactions. In: Pers Soc Psychol Bull. DOI: 10.1177/0146167214538459.

The present research investigated whether having out-group friends serves as a buffer for feeling misunderstood in interracial interactions. Across three experience sampling studies, we found that among ethnic minorities who have few White friends or are not interacting with White friends, daily interracial interactions are associated with feeling less understood. By contrast, we found that among ethnic minorities who have more White friends or are interacting with White friends, the relationship between daily interracial interactions and feeling understood is not significant. We did not find similar results for Whites; that is, having ethnic minority friends did not play a role in the relationship between daily interracial interactions and feeling understood. Together, these studies demonstrate the beneficial effects of intergroup friendships for ethnic minorities.

Shuren, J. (2014): The FDA’s role in the development of medical mobile applications. In: Clin Pharmacol Ther 95 (5), S. 485–488. DOI: 10.1038/clpt.2014.45.

The use of mobile apps is revolutionizing health-care delivery and has the potential to transform health care by allowing doctors to diagnose patients with potentially life-threatening conditions outside traditional health-care settings, as well as helping consumers manage their own health and wellness and gain access to useful information when and where they need it.

Silva, Joana; Monteiro, Miguel; Sousa, Filipe (2014): Human activity classification with inertial sensors. In: Stud Health Technol Inform 200, S. 101–104.

Monitoring human physical activity has become an important research area and is essential to evaluate the degree of functional performance and general level of activity of a person. The discrimination of daily living activities can be implemented with machine learning techniques. A public dataset provided during the European Symposium on Artificial Neural Networks 2013, with time and frequency domain features extracted from raw signals of the smartphone inertial sensors, was used to implement and evaluate an activity classifier. Using a decision tree classifier, an accuracy of 86% was achieved for the classification of walk, climb stairs, stand, sit, and lay down. The results obtained suggest that the smartphone’s inertial sensors could be used for an accurate physical activity classification even with real-time requirements.

Silvia, Paul J.; Beaty, Roger E.; Nusbaum, Emily C.; Eddington, Kari M.; Levin-Aspenson, Holly; Kwapil, Thomas R. (2014): Everyday creativity in daily life: An experience-sampling study of “little c” creativity. In: Psychology of Aesthetics, Creativity, and the Arts 8 (2), S. 183–188. DOI: 10.1037/t05569-000;

Richards proposed that everyday creativity—creative actions that are common among ordinary people in daily life, such as drawing, making recipes, writing, and any activity done with the purpose of being creative—both fosters and reflects psychological health. To explore when people are more likely to do something creative during the day, and to see who tends to act more creatively, we conducted a week-long experience-sampling study with a sample of young adults. Throughout the day, people’s actions and feelings were randomly sampled, with an emphasis on whether people were doing something creative. Consistent with the notion of everyday creativity as a psychological strength, within-person models showed that people who reported feeling happy and active were more likely to be doing something creative at the time. Between-person models found that openness to experience and conscientiousness had large effects on whether people spent their time on creative pursuits. Neither negative states (e.g., momentary feelings of anger, stress, and self-consciousness) nor traits (e.g., neuroticism) significantly predicted creative activity. The findings support Richards’s theorizing about everyday creative behavior as a cause and effect of positive psychological processes, and they illustrate the value of experience sampling for uncovering what creativity looks like in people’s idiosyncratic environments.

Simons, Jeffrey S.; Wills, Thomas A.; Neal, Dan J. (2014): The Many Faces of Affect: A Multilevel Model of Drinking Frequency/Quantity and Alcohol Dependence Symptoms Among Young Adults. In: J Abnorm Psychol. DOI: 10.1037/a0036926.

This research tested a multilevel structural equation model of associations between 3 aspects of affective functioning (state affect, trait affect, and affective lability) and 3 alcohol outcomes (likelihood of drinking, quantity on drinking days, and dependence symptoms) in a sample of 263 college students. Participants provided 49 days of experience sampling data over 1.3 years in a longitudinal burst design. Within-person results: At the daily level, positive affect was directly associated with greater likelihood and quantity of alcohol consumption. Daily negative affect was directly associated with higher consumption on drinking days and with higher dependence symptoms. Between-person direct effects: Affect lability was associated with higher trait negative, but not positive, affect. Trait positive affect was inversely associated with the proportion of drinking days, whereas negative affectivity predicted a greater proportion of drinking days. Affect lability exhibited a direct association with dependence symptoms. Between-person indirect effects: Trait positive affect was associated with fewer dependence symptoms via proportion of drinking days. Trait negative affect was associated with greater dependence symptoms via proportion of drinking days. The results distinguish relations of positive and negative affect to likelihood versus amount of drinking and state versus trait drinking outcomes, and highlight the importance of affect variability for predicting alcohol dependence symptoms.

Thompson, Wesley K.; Gershon, Anda; O’Hara, Ruth; Bernert, Rebecca A.; Depp, Colin A. (2014): The prediction of study-emergent suicidal ideation in bipolar disorder: a pilot study using ecological momentary assessment data. In: Bipolar Disord. DOI: 10.1111/bdi.12218.

OBJECTIVES: Bipolar disorder is associated with idiosyncratic precursors of clinically important states such as suicidal ideation. Ecological momentary assessment (EMA) - high frequency data collection in a subject’s usual environment - provides the potential for development of temporal, individualized prediction of risk states. The present study tested the ability of EMA data to predict individual symptom change in clinician-rated suicidal ideation. METHODS: Thirty-five adults diagnosed with inter-episode bipolar disorder completed daily measures of affect in their home environments using diaries administered over an eight-week assessment timeline. Suicidal ideation was assessed monthly at in-person visits using the Inventory of Depressive Symptomatology-Clinician Rated. We used a novel application of functional linear models (FLMs) to generate prospective predictions of suicidal ideation at in-person clinician assessments based on intensively sampled trajectories of daily affect. RESULTS: Eight instances of suicidal ideation scores > 0 were recorded during the study period on six participants. Utilizing trajectories of negative and positive affect, cross-validated predictions attained 88% sensitivity with 95% specificity for elevated suicidal ideation one week prior to in-person clinician assessment. This model strongly outperformed prediction models using cross-sectional data obtained at study visits alone. CONCLUSIONS: Utilizing EMA data with FLM prediction models substantially increases the accuracy of prediction of study-emergent suicidal ideation. Prediction algorithms employing intensively sampled longitudinal EMA data could sensitively detect the warning signs of suicidal ideation to facilitate improved suicide risk assessment and the timely delivery of preventative interventions.

Thrul, Johannes; Buhler, Anneke; Ferguson, Stuart G. (2014): Situational and mood factors associated with smoking in young adult light and heavy smokers. In: Drug Alcohol Rev. DOI: 10.1111/dar.12164.

INTRODUCTION AND AIMS: Antecedents of smoking have been widely researched in studies with older adults. However, less is known about the smoking patterns and antecedents of smoking in young adult smokers. DESIGN AND METHODS: In this study, we used ecological momentary assessment collected with an Internet-based survey instrument and used the participants’ own mobile phones to contrast the smoking patterns of young adult light and intermittent smokers (n = 23) with heavy smokers (n = 18). Overall, 1543 smoking and non-smoking situations were analysed. By means of generalised estimating equations, we used a range of situational characteristics to predict smoking in both groups. RESULTS: Craving and smoking of others increased the odds of smoking, and smoking bans were associated with a decreased probability of smoking among both light and intermittent smokers and heavy smokers. Situational antecedents differed between both groups. Cue-associated smoking played a bigger role for light and intermittent smokers than for heavy smokers. Situational antecedents, such as craving, being at the home of others, drinking alcohol and smoking by others, were more strongly associated with the smoking of light and intermittent smokers compared with heavy smokers. DISCUSSION AND CONCLUSIONS: Smoking among young adults is associated with both internal and external situational characteristics. Compared with heavy smokers, light and intermittent smoking seems to be under more stimulus control and more characterised by social smoking. These results are consistent with several findings from previous studies and provide further information on different subgroups of smokers in early adulthood. [Thrul J, Buhler A, Ferguson SG. Situational and mood factors associated with smoking in young adult light and heavy smokers. Drug Alcohol Rev 2014].

Tilley, P J Matt; Rees, Clare S. (2014): A clinical case study of the use of ecological momentary assessment in obsessive compulsive disorder. In: Front Psychol 5, S. 339. DOI: 10.3389/fpsyg.2014.00339.

Accurate assessment of obsessions and compulsions is a crucial step in treatment planning for Obsessive-Compulsive Disorder (OCD). In this clinical case study, we sought to determine if the use of Ecological Momentary Assessment (EMA) could provide additional symptom information beyond that captured during standard assessment of OCD. We studied three adults diagnosed with OCD and compared the number and types of obsessions and compulsions captured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) compared to EMA. Following completion of the Y-BOCS interview, participants then recorded their OCD symptoms into a digital voice recorder across a 12-h period in reply to randomly sent mobile phone SMS prompts. The EMA approach yielded a lower number of symptoms of obsessions and compulsions than the Y-BOCS but produced additional types of obsessions and compulsions not previously identified by the Y-BOCS. We conclude that the EMA-OCD procedure may represent a worthy addition to the suite of assessment tools used when working with clients who have OCD. Further research with larger samples is required to strengthen this conclusion.

Timmers, Corrie; Maeghs, Anne; Vestjens, Michiel; Bonnemayer, Charlie; Hamers, Huub; Blokland, Arjan (2014): Ambulant cognitive assessment using a smartphone. In: Appl Neuropsychol Adult 21 (2), S. 136–142. DOI: 10.1080/09084282.2013.778261.

The focus of neuropsychology is to understand the relationship between assessment results and everyday cognitive abilities and disabilities. However, the generalizability of traditional neuropsychological tests to real-life behaviors, the ecological validity, is compromised by the test environment, among other things. Neuropsychological tests are often completed in a laboratory setting that is typically quiet with few distractions. This is very unlike most everyday environments. The aim of the present study was to investigate the possibility of using a smartphone in standardized cognitive assessment. A short-term memory task was obtained from young adults in either an everyday-life environment or a controlled test setting at four time points during a day. Results show no significant differences between the task performances in both conditions. There was no indication that fatigue, tension, or environmental noise had an effect on task performance. High correlations between subsequent time points were found in the everyday-life environment, suggesting a high test-retest reliability and commitment of the participants. The present study demonstrates that smartphones can be used to assess cognitive functions outside a laboratory setting.

Tomko, Rachel L.; Solhan, Marika B.; Carpenter, Ryan W.; Brown, Whitney C.; Jahng, Seungmin; Wood, Phillip K.; Trull, Timothy J. (2014): Measuring impulsivity in daily life: The Momentary Impulsivity Scale. In: Psychological Assessment 26 (2), S. 339–349. Online verfügbar unter

Impulsivity is a core feature of many psychiatric disorders. Traditionally, impulsivity has been assessed using retrospective questionnaires or laboratory tasks. Both approaches neglect intraindividual variability in impulsivity and do not capture impulsivity as it occurs in real-world settings. The goal of the current study was to provide a method for assessing impulsivity in daily life that provides both between-individual and within-individual information. Participants with borderline personality disorder (BPD; n = 67) or a depressive disorder (DD; n = 38) carried an electronic diary for 28 days and responded to 9 impulsivity items up to 6 times per day. Item distributions and iterative exploratory factor analysis (EFA) results were examined to select the items that best captured momentary impulsivity. A brief 4-item scale was created that can be used for the assessment of momentary impulsivity. Model fit was good for both within- and between-individual EFA. As expected, the BPD group showed significantly higher scores on our Momentary Impulsivity Scale than the DD group, and the resulting scale was moderately correlated with common trait impulsivity scales.

Udachina, Alisa; Varese, Filippo; Myin-Germeys, Inez; Bentall, Richard P. (2014): The role of experiential avoidance in paranoid delusions: An experience sampling study. In: Br J Clin Psychol. DOI: 10.1111/bjc.12054.

OBJECTIVES: The study examined (1) the role of experiential avoidance (EA), conceptualized as intolerance towards aversive mental states, in paranoid delusions and (2) the mechanisms underlying EA. DESIGN: A 6-day prospective momentary assessment study. METHODS: Paranoid patients (N = 41) were studied using the experience sampling method (ESM), a structured diary technique, assessing psychopathology and current context in daily life. RESULTS: The results showed that both low self-esteem and EA contributed to paranoid thinking. The relationship between low self-esteem and paranoia was partially mediated by EA and the relationship between EA and paranoia was partially mediated by low self-esteem. The detrimental effect of EA on self-esteem was more pronounced under high activity-related stress. Both EA and social stress were independently associated with low self-esteem. EA was associated with self-esteem instability. CONCLUSIONS: Our results implicate mental control strategies in the development of paranoia and are compatible with the attributional model of paranoia, which suggests that persecutory delusions arise as a result of dysfunctional attempts to avoid unpleasant thoughts about the self. PRACTITIONER POINTS: Interventions for paranoid individuals should target low tolerance towards negative mental states, for example using mindfulness and ACT therapeutic approaches. Interventions designed for individuals suffering from persecutory delusions should also address unfavourable views about the self. LIMITATIONS: Avoidance of unpleasant mental states may operate outside the individual’s awareness and self-report measures of EA may be unable to adequately tap this process. Self-reflection abilities of psychotic patients may be impaired.

Vanhelst, Jeremy; Fardy, Paul S.; Beghin, Laurent (2014): Technical variability of the Vivago wrist-worn accelerometer. In: J Sports Sci, S. 1–7. DOI: 10.1080/02640414.2014.918643.

Abstract The aim was to assess the technical variability of a new wrist-worn accelerometer under controlled conditions with a shaker device and during normal daily physical activities (PAs). In the first experiment, 10 wrist-worn accelerometers (Vivago(R) Wellness, Paris, France) were attached to the shaker device. Variability was tested at five shaking frequencies (1.1, 2.1, 3.1, 4.1, and 10 Hz) for 10 min at each frequency. In the second experiment, 21 participants wore wrist-worn accelerometers and performed six consecutive 10-min periods of activity at increasing levels of intensity from sedentary to vigorous. Results from the first experiment show a modest inter- and intra-instrument reliability at low frequencies and that reliability improved as frequency increased. The inter-instrument coefficient of variation (CV) was 2.6-18.3%. The intra-instrument CV was 4.1-23.2%. Variability was similar in the second experiment with a CV inversely related to PA intensity. The inter- and intra-instrument CV varied from 24.2% and 19.9% for sedentary activities to 3.7% and 4.3% for vigorous PA, respectively. Results suggest that reliability was higher at high intensities, corresponding to moderate and vigorous PA, intensities generally recommended for public health purposes.

Vasilenko, Sara A.; Piper, Megan E.; Lanza, Stephanie T.; Liu, Xiaoyu; Yang, Jingyun; Li, Runze (2014): Time-varying processes involved in smoking lapse in a randomized trial of smoking cessation therapies. In: Nicotine Tob Res 16 Suppl 2, S. S135-43. DOI: 10.1093/ntr/ntt185.

INTRODUCTION: Researchers have increasingly begun to gather ecological momentary assessment (EMA) data on smoking, but new statistical methods are necessary to fully unlock information from such data. In this paper, we use a new technique, the logistic time-varying effect model (logistic TVEM), to examine the odds of smoking in the 2 weeks after a quit attempt. METHODS: Data are from a subsample of participants from a randomized, placebo-controlled trial of smoking cessation pharmacotherapies who achieved initial abstinence (N = 1,106, 58% female). Participants completed up to 4 EMA assessments per day during the 2 weeks after their quit day. Predictors include baseline nicotine dependence, EMA measures of craving and negative affect, and whether an individual was assigned to a placebo, monotherapy, or combination therapy condition. Time-varying effects of these predictors were estimated using logistic TVEM. RESULTS: Cravings were a significant predictor of smoking throughout the entire 2 weeks postquit, whereas the effect of baseline dependence became nonsignificant by the second week, and the effect of negative affect increased over time. Individuals in the monotherapy and combination therapy conditions had decreased odds of smoking compared with placebo in the first week postquit, but these differences were nonsignificant in the second week. CONCLUSIONS: Findings suggest that pharmacotherapies are more effective compared with placebo earlier in a quit attempt, when the effect of baseline nicotine dependence on smoking is stronger, whereas the effect of craving and negative affect increased over time. Future cessation therapies may be more successful by providing additional support in the second week after quit attempt.

Vega, Rocio de la; Roset, Roman; Castarlenas, Elena; Sanchez-Rodriguez, Elisabet; Sole, Ester; Miro, Jordi (2014): Development and testing of Painometer: a Smartphone app to assess pain intensity. In: J Pain. DOI: 10.1016/j.jpain.2014.04.009.

The so-called electronic and information technologies (EITs) are increasingly being used to assess pain. This study aims (1) to introduce Painometer, a Smartphone app that helps users to assess pain intensity, and (2) to report on its usability (i.e., user performance and satisfaction) and acceptability (i.e. the willingness to use it) when it is used by healthcare professionals and non-professionals. Painometer includes four well-known pain intensity scales: the Faces Pain Scale-Revised, the Numerical Rating Scale-11, the Coloured Analogue Scale, and the Visual Analogue Scale. Scores reported with these scales, when used in its traditional format, have demonstrated to be valid and reliable. The app was tested in a sample of 24 healthcare professionals, and 30 non-professionals. Two iterative usability cycles were conducted with a qualitative usability testing approach and a semi-structured interview. The participants had an average of 10 years’ experience in using computers. The domains measured were ease of use, errors in usage, most popular characteristics, suggested changes and acceptability. Adding instructions and changing format and layout details solved the usability problems reported in cycle 1. No further problems were reported in cycle 2. Painometer has been found to be a useful, user-friendly app that may help to improve the accuracy of pain intensity assessment. PERSPECTIVE: Painometer, a Smarphone application to assess pain intensity, shows good usability and acceptability properties when used by healthcare professionals and non-professional users.

Vrijheid, Martine (2014): The exposome: a new paradigm to study the impact of environment on health. In: Thorax. DOI: 10.1136/thoraxjnl-2013-204949.

Environmental factors, here taken to include pollutants, lifestyle factors and behaviours, can play an important role in serious, chronic pathologies with large societal and economic costs, including respiratory disease. However, measurement of the environmental component in epidemiological studies has traditionally relied on much more uncertain and incomplete assessments than measurement of the genome. The ‘exposome’ has therefore been proposed as a new paradigm to encompass the totality of human environmental (meaning all non-genetic) exposures from conception onwards, complementing the genome. Evidently, there are large challenges in developing the exposome concept into a workable approach for epidemiological research. These include: (1) the accurate and reliable measurement of many exposures in the external environment, (2) the measurement of a wide range of biological responses in the internal environment, and (3) addressing the dynamic, life course nature of the exposome. New tools and technologies that can be applied to address these challenges include exposure biomarker technologies, geographical mapping and remote sensing technologies, smartphone applications and personal exposure sensors, and high-throughput molecular ‘omics’ techniques. Prospective, population-based cohort studies have recently started to implement these methods using the exposome framework. The exposome thus offers a new and exciting paradigm for improvement and integration of currently scattered and uncertain data on the environmental component in disease aetiology. This should lead to a better understanding of the role of environmental risk factors in respiratory disease and other chronic pathologies, and ultimately to better primary prevention strategies.

Wagner, David T.; Barnes, Christopher M.; Scott, Brent A. (2014): Driving it home: How workplace emotional labor harms employee home life. In: Personnel Psychology 67 (2), S. 487–516. DOI: 10.1037/t16260-000.

To date, the majority of research on emotional labor has focused on outcomes that occur in the workplace. However, research has yet to consider the possibility that the daily effects of emotional labor spill over to life outside of work, even though a large body of literature examining the spillover from work life to home life indicates that work experiences influence employees after they leave the workplace. Accordingly, we examined the influence of day‐to‐day surface acting on 3 types of theoretically derived stress outcomes experienced at home: emotional exhaustion, work‐to‐family conflict, and insomnia. In an experience sampling field study of 78 bus drivers, we found that daily surface acting was connected to increases in each of the outcomes noted above. Moreover, surface acting had an indirect effect on emotional exhaustion and insomnia via state anxiety.

White, Andrew J.; Umpfenbach, Katja; Alpers, Georg W. (2014): Where have they gone? Tracking movement patterns to document the process of situational exposure in agoraphobia. In: Professional Psychology: Research and Practice 45 (3), S. 171–179. Online verfügbar unter

Therapists typically have limited information about how unaccompanied situational exposure is undertaken. To address this issue, we present a method of assessing movement patterns and concurrent arousal collected during situational exposure. We illustrate how this provides both objective and useful accounts of this important treatment component. In this case study, recordings of global positioning system-derived position and heart rate were obtained from a 47-year-old female patient suffering from panic disorder with agoraphobia who received treatment through an outpatient clinic. Ambulatory assessment of movement and accompanying physiology (heart rate) during situational exposure is described. Visualizations of positional and physiological data recorded during exposure sessions revealed (a) that the patient actually confronted feared environmental cues, (b) that she experienced elevated physiological arousal, and (c) good therapeutic compliance. These depictions were used to plan subsequent exposure sessions and we discuss how this information provided unique insights into the process of exposure. Assessment of movement patterns using commercially available technology can yield clinically relevant information about treatment progress. We conclude that this method could extend traditional self-report measures of agoraphobic avoidance. Future directions, such as the possibility of using movement information to refine follow-up assessment, and the limitations of this approach are discussed.

Wile, Daryl J.; Ranawaya, Ranjit; Kiss, Zelma H T (2014): Smart watch accelerometry for analysis and diagnosis of tremor. In: J Neurosci Methods 230, S. 1–4. DOI: 10.1016/j.jneumeth.2014.04.021.

BACKGROUND: Distinguishing the postural re-emergent tremor of Parkinson disease from essential tremor can be difficult clinically. Use of accelerometry to aid diagnosis is limited to laboratory settings. We sought to record and differentiate these tremors using a smart watch device in an outpatient clinic. NEW METHOD: 41 patients were enrolled. Recordings were made with a smart watch device on the predominantly affected hand (all patients), and simultaneously with an analog accelerometer (10 patients) with hands at rest and outstretched. Tremor peak frequency, peak power, and power of the first four harmonics was calculated and compared between the two devices. Mean power at the first four harmonics was calculated and used to classify tremor as parkinsonian or essential. Test characteristics were calculated to compare the device and clinical diagnoses. RESULTS: Mean harmonic peak power was both highly sensitive and specific for distinction of Parkinson disease postural tremor from essential tremor with an optimal threshold for our sample (sensitivity 90.9%, 95% CI 58.7-99.8%; specificity 100%, 95% CI 76.8-100%; Cohen’s kappa=0.91, SE=0.08). COMPARISON WITH EXISTING METHODS: The smart watch and analog devices had nearly perfect concordance of peak frequency and proportional harmonic power. The smart watch recordings in clinic took 3-6 min. CONCLUSIONS: A smart watch device can provide accurate and diagnostically relevant information about postural tremor. Its portability and ease of use could help translate such techniques into routine clinic use or to the community.

Wilson, Sarah M.; Dedert, Eric A.; Dennis, Paul A.; Dennis, Michelle F.; Calhoun, Patrick S.; Kirby, Angela C.; Beckham, Jean C. (2014): Do ethnicity and gender moderate the influence of posttraumatic stress disorder on time to smoking lapse? In: Addict Behav 39 (7), S. 1163–1167. DOI: 10.1016/j.addbeh.2014.03.016.

BACKGROUND: Following a smoking cessation attempt, smokers with posttraumatic stress disorder (PTSD) experience smoking relapse at a higher and faster rate. Black ethnicity and female gender are also associated with lower success rates following smoking cessation. No study to date has prospectively examined how ethnicity and gender may moderate the effect of PTSD on smoking relapse. It was hypothesized that female gender and Black ethnicity would significantly predict early lapse after quitting; further, it was predicted that ethnicity and gender would moderate the effect of PTSD on relapse rate. METHODS: Smokers with PTSD (n=48) and without PTSD (n=56) completed ecological momentary assessment (EMA) the week after a quit date, and self-initiated EMA entries after smoking lapse. Smoking abstinence was biologically verified. The sample included Black (62%) and White (38%) participants, and was 50% female. Study hypotheses were tested with Cox proportional hazards regression modeling time to first smoking lapse. RESULTS: Study results confirmed the main hypothesis, with a significant PTSD x Ethnicity interaction emerging. The effect of PTSD on smoking relapse was significant for White participants but not for Black participants. No significant gender moderation was found. CONCLUSION: Taken together, study results support previous research, and suggest that the relationship between smoking and PTSD is stronger for White smokers than for minorities. This study has significant implications for research in smoking and mental disease, as well as for smoking cessation treatments for Black smokers.

Wrzus, Cornelia; Wagner, Gert G.; Riediger, Michaela (2014): Feeling good when sleeping in? Day-to-day associations between sleep duration and affective well-being differ from youth to old age. In: Emotion 14 (3), S. 624–628. Online verfügbar unter

The current study investigated how night-to-night variations in sleep duration relate to affective well-being the next morning as well as how the relationship varies for people of different ages. Using an Experience Sampling approach, 397 participants aged 12 to 88 years reported their sleep duration and their momentary affect on 9 mornings, on average. Associations between sleep duration during the previous night and morning affect differed depending on the participants’ age. For adolescents, for example, affective well-being in the morning was worse the shorter participants had slept the previous night. For adults aged over 20 years, however, affective well-being was worse following nights with shorter or longer than average sleep duration. This effect was more pronounced the older the participants were. The findings demonstrate that the importance of sleep duration for daily affective well-being is better understood when considering the age of the sleeper. In adults, but not adolescents, not only sleeping less but also sleeping more than one’s average can be associated with lower affective well-being.

Zuzanek, Jiri; Zuzanek, Tamara (2014): Of happiness and of despair, is there a measure? Time use and subjective well-being. In: Journal of Happiness Studies. Online verfügbar unter

Data from the 1975 U.S. time use survey, Canadian time use surveys (GSS) conducted from 1986 to 2010, and experience sampling surveys (ESM) conducted in 1985 and 2003 at the University of Waterloo (Canada) are used to examine well-being effects of time use. Indicators of subjective well-being (SWB) under investigation include: (a) generalised enjoyment ratings of selected daily activities; (b) reporting of the single most enjoyed activity performed on the time diary day; (c) affect ratings of daily activities recorded in ESM surveys at the time of their occurrence; (d) correlations between time use and levels of respondents’ perceived happiness and life satisfaction, and (e) relationships between frequency of participation in different groups of daily activities and respondents’ cumulative affect ratings during a survey week (ESM 1985, 2003). An argument is made that attempts to delineate indices of SWB as multiples of activity enjoyment ratings and their duration encounter considerable measurement and conceptual difficulties. It is suggested that prolonged exposure to highly enjoyed daily activities does not always foretell higher levels of cumulative subjective well-being, which is associated with balanced use of time rather than increased participation in individual activities.

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