Society for Ambulatory Assessment

Second quarter 2010 (April to June)

Anestis MD, Selby EA, Crosby RD, Wonderlich SA, Engel SG, Joiner TE. (Jul 2010). A comparison of retrospective self-report versus ecological momentary assessment measures of affective lability in the examination of its relationship with bulimic symptomatology. Behav Res Ther, 48(7), 607-13.

Affective lability has been linked to several maladaptive behaviors (Anestis et al., 2009; Coccaro, 1991). Methodology for measuring affective lability varies and includes retrospective self-report and ecological momentary assessment (EMA). In this study, we sought to test these methodologies by examining which better predicted binge eating episodes and general eating disorder symptoms in a sample (n = 131) of women diagnosed with bulimia nervosa (BN). We hypothesized that, while the two forms of measurement would be correlated with one another and predict binge eating episodes, EMA affective lability would be the stronger predictor. Results supported several hypotheses. Specifically, both EMA affective lability and retrospective self-report affective lability significantly predicted global eating disorder symptoms, even when controlling for depression, age, body mass index, and level of education, EMA affective lability exhibited a significantly stronger correlation with binge eating episodes than did retrospective self-report affective lability, and EMA affective lability predicted number of binge eating episodes on any given day controlling for the same list of covariates. Limitations include the use of a clinical sample that may limit the generalizability of our findings. Findings highlight the importance of affect in such behavior.

Ben-Zeev D, Young MA. (Apr 2010). Accuracy of hospitalized depressed patients’ and healthy controls’ retrospective symptom reports: An experience sampling study. Journal of Nervous and Mental Disease, 198(4), 280-285.

A growing body of literature suggests that retrospective recall of psychiatric symptoms is often inaccurate and may distort knowledge about the course of illness and impact treatment. The current study examined the accuracy of retrospective recall of a variety of depressive symptoms in hospitalized depressed patients and nonclinical controls. Using the Experience Sampling Method, we compared average momentary symptom reports of 1 week to retrospective summaries of the same period. The depressed group exhibited negative biases in their recall of experienced anhedonia, sadness, confusion, and suicidality, but were relatively accurate in recall of helplessness, detachment, and self-control. Controls exhibited a different pattern; they were relatively accurate in their retrospective recall of confusion, suicidality and sadness, but exhibited positive biases in recall of anhedonia, helplessness, detachment, and self-control. Both groups exhibited comparable negative biases in their recall of experienced tension, difficulty concentrating, guilt, and fear. The findings suggest that for maximum accuracy in the assessment of depressive symptoms, scientists and practitioners should supplement retrospective self-reports with momentary measures, and consider using ambulatory assessment in cognitive behavioral treatments of depression.

Berle JO, Hauge ER, Oedegaard KJ, Holsten F, Fasmer OB. (May 2010). Actigraphic registration of motor activity reveals a more structured behavioural pattern in schizophrenia than in major depression. BMC Res Notes, 3, 149.

BACKGROUND: Disturbances in motor activity pattern are seen in both schizophrenia and depression. However, this activity has rarely been studied objectively. The purpose of the present study has been to study the complexity of motor activity patterns in these patients by using actigraphy. FINDINGS: Motor activity was recorded using wrist-worn actigraphs for periods of 2 weeks in patients with schizophrenia and major depression and compare them to healthy controls. Average motor activity was recorded and three non-parametric variables, interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA) were calculated on the basis of these data. The motor activity was significantly lower both in patients with schizophrenia (153 +/- 61, mean +/- SD, p < 0.001) and depression (187 +/- 84, p < 0.001), compared to controls (286 +/- 80). The schizophrenic patients had higher IS and lower IV than the controls reflecting a more structured behavioural pattern. This pattern was particularly obvious in schizophrenic patients treated with clozapine and was not found in depressed patients. CONCLUSIONS: Motor activity was significantly reduced in both schizophrenic and depressed patients. However, schizophrenic patients differed from both depressed patients and controls, demonstrating motor activity patterns marked by less complexity and more structured behaviour. These findings may indicate that disturbances in motor activity reflect different pathophysiological mechanisms in schizophrenia compared to major depression.

Bower B, Bylsma LM, Morris BH, Rottenberg J. (Jun 2010). Poor reported sleep quality predicts low positive affect in daily life among healthy and mood-disordered persons.  J Sleep Res, 19(2), 323-32.

Sleep disturbance is a core symptom of mood disorders. However, surprisingly little is known about the relationship between sleep quality and ambulatory daily mood, especially in mood-disordered populations. We assessed ambulatory positive affect (PA) and negative affect (NA) 10 times daily for three consecutive days with the computerized experience sampling method among persons with major depression (n = 35), minor depression (n = 25) and healthy controls (n = 36). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Poorer sleep quality predicted lower ambulatory PA, even after accounting for the effects of diagnostic group and self-reported anxiety. Conversely, sleep quality did not predict ambulatory NA once diagnostic group was accounted for. Analyzes of specific PSQI component scores indicated that poor subjective sleep quality and self-reported daytime dysfunction were the sleep components most strongly tied to reports of low ambulatory PA. Impaired sleep quality may be responsible for reduced pleasurable experience in everyday life.

Burt SA, Donnellan MB. (Jun 2010). Evidence that the Subtypes of Antisocial Behavior Questionnaire (STAB) predicts momentary reports of acting-out behaviors. Personality and Individual Differences,  48(8), 917-920.

There is growing recognition that substantively important distinctions exist across physically aggressive, rule-breaking, and socially aggressive forms of antisocial behavior. Even so, one limitation to accumulating additional scientific insights into the correlates and origins of these three varieties of antisocial behavior has been the lack of an efficient self-report assessment in the public domain. The Subtypes of the Antisocial Behavior Questionnaire (STAB) was developed to address this need. Although there is already a good deal of psychometric support for the STAB, prior research has yet to examine its “ecological” validity. In other words, it remains unclear whether the STAB scales would predict the frequency of acting-out behaviors in daily life. The current study sought to examine this question via an electronic diary study, in which participants reported on their momentary behaviors on multiple occasions in their natural environments. Analyses revealed that each STAB scale uniquely predicted only the momentary acting-out behaviors characteristic of that scale. Such findings provide further support for the STAB as a promising self-report measure of physically aggressive, rule-breaking, and socially aggressive forms of antisocial behavior.

Butte NF, Wong WW, Adolph AL, Puyau MR, Vohra FA, Zakeri IF. (Jun 2010). A comparison of retrospective self-report versus ecological momentary assessment measures of affective lability in the examination of its relationship with bulimic symptomatology. J Nutr [Epub ahead of print].

Accurate, nonintrusive, and inexpensive techniques are needed to measure energy expenditure (EE) in free-living populations. Our primary aim in this study was to validate cross-sectional time series (CSTS) and multivariate adaptive regression splines (MARS) models based on observable participant characteristics, heart rate (HR), and accelerometer counts (AC) for prediction of minute-by-minute EE, and hence 24-h total EE (TEE), against a 7-d doubly labeled water (DLW) method in children and adolescents. Our secondary aim was to demonstrate the utility of CSTS and MARS to predict awake EE, sleep EE, and activity EE (AEE) from 7-d HR and AC records, because these shorter periods are not verifiable by DLW, which provides an estimate of the individual’s mean TEE over a 7-d interval. CSTS and MARS models were validated in 60 normal-weight and overweight participants (ages 5-18 y). The Actiheart monitor was used to simultaneously measure HR and AC. For prediction of TEE, mean absolute errors were 10.7 +/- 307 kcal/d and 18.7 +/- 252 kcal/d for CSTS and MARS models, respectively, relative to DLW. Corresponding root mean square error values were 305 and 251 kcal/d for CSTS and MARS models, respectively. Bland-Altman plots indicated that the predicted values were in good agreement with the DLW-derived TEE values. Validation of CSTS and MARS models based on participant characteristics, HR monitoring, and accelerometry for the prediction of minute-by-minute EE, and hence 24-h TEE, against the DLW method indicated no systematic bias and acceptable limits of agreement for pediatric groups and individuals under free-living conditions.

Connelly M, Miller T, Gerry G, Bickel J. (May 2010). Electronic momentary assessment of weather changes as a trigger of headaches in children. Headache, 50(5), 779-89.

BACKGROUND: Variables that are thought to precipitate migraine or tension-type headache episodes in children hitherto have only been studied using retrospective reports. As such, there is little empirical evidence to support the actual predictive association between presumed headache triggers and actual headache occurrence in children. OBJECTIVE: The present study sought to determine if fluctuations in weather, a commonly reported headache trigger in children, predict increased likelihood of headache occurrence when evaluated using rigorous prospective methodology (“electronic momentary assessment”). METHODS: Twenty-five children (21 girls, 4 boys) between the ages of 8-17 years attending a new patient neurology clinic appointment and having a diagnosis of chronic migraine, chronic tension-type, or episodic migraine headache (with or without aura) participated in the study. Children completed baseline measures on headache characteristics, presumed headache triggers, and mood and subsequently were trained in the use of electronic diaries to record information on headaches. Children then completed thrice daily diaries on handheld computers for a 2-week time period (42 assessments per child) while data on weather variables (temperature, dew point temperature, barometric pressure, humidity, precipitation, and sunlight) in the child’s geographic location were recorded each time a diary was completed. Data were analyzed using multilevel models. RESULTS: Of the weather variables, relative humidity and presence of precipitation were significantly predictive of new headache onset, with nearly a 3-fold increase in probability of headache occurrence during times of precipitation or elevated humidity in the child’s area, b = 0.38, t(821) = 2.10, P = .04, and b = 0.02, t(821) = 2.81, P = .01, respectively. These associations remained after accounting for fluctuations in mood, and associations were not significantly stronger in children who at baseline thought that weather was a headache trigger for them. Changes in temperature, dew point temperature, barometric pressure, and sunlight were not significantly predictive of new headache episode occurrence in this sample. CONCLUSIONS: Results of the present study lend some support to the belief commonly held by children with recurrent headaches that weather changes may contribute to headache onset. Although electronic momentary assessment methodology was found to be feasible in this population and to have the potential to identify specific headache triggers for children, it remains to be determined how best (or even whether) to incorporate this information into treatment recommendations.

Cook PF, McElwain CJ, Bradley-Springer LA. (Jun 2010). Feasibility of a daily electronic survey to study prevention behavior with HIV-infected individuals. Res Nurs Health, 33(3), 221-34.

The daily experiences of persons living with HIV (PLWH) are important but under-studied as predictors of HIV prevention behavior. Ecological momentary assessment (EMA) is an intensive within-subjects data collection method that can be used to examine daily experiences. To determine whether PLWH would participate in EMA, we conducted a feasibility study with 21 PLWH. The method was acceptable to men and women from diverse backgrounds, with 81% (17/21) completing 2 months of daily surveys, and 67% (14/21) completing 6 months. Measures were completed on 72% of study days. Only 6% of records had missing data. Daily survey completion decreased over time. Participants reported that EMA was easy and did not influence their behaviors. Results suggest EMA is feasible with PLWH. (c) 2010 Wiley Periodicals, Inc.

Cooper AR, Page AS, Wheeler BW, Hillsdon M, Griew P, Jago R. (Apr 2010). Patterns of GPS measured time outdoors after school and objective physical activity in English children: the PEACH project. Int J Behav Nutr Phys Act, 22(7), 31.

BACKGROUND: Observational studies have shown a positive association between time outdoors and physical activity in children. Time outdoors may be a feasible intervention target to increase the physical activity of youth, but methods are required to accurately measure time spent outdoors in a range of locations and over a sustained period. The Global Positioning System (GPS) provides precise location data and can be used to identify when an individual is outdoors. The aim of this study was to investigate whether GPS data recorded outdoors were associated with objectively measured physical activity. METHODS: Participants were 1010 children (11.0 +/- 0.4 years) recruited from 23 urban primary schools in South West England, measured between September 2006 and July 2008. Physical activity was measured by accelerometry (Actigraph GT1M) and children wore a GPS receiver (Garmin Foretrex 201) after school on four weekdays to record time outdoors. Accelerometer and GPS data were recorded at 10 second epochs and were combined to describe patterns of physical activity when both a GPS and accelerometer record were present (outdoors) and when there was accelerometer data only (indoors). ANOVA was used to investigate gender and seasonal differences in the patterns of outdoor and indoor physical activity, and linear regression was used to examine the cross-sectional associations between GPS-measured time outdoors and physical activity. RESULTS: GPS-measured time outdoors was a significant independent predictor of children’s physical activity after adjustment for potential confounding factors. Physical activity was more than 2.5 fold higher outdoors than indoors (1345.8 +/- 907.3 vs 508.9 +/- 282.9 counts per minute; F = 783.2, p < .001). Overall, children recorded 41.7 +/- 46.1 minutes outdoors between 3.30 pm and 8.30 pm, with more time spent outdoors in the summer months (p < .001). There was no gender difference in time spent outdoors. Physical activity outdoors was higher in the summer than the winter (p < .001), whilst there was no seasonal variation in physical activity indoors. CONCLUSIONS: Duration of GPS recording is positively associated with objectively measured physical activity and is sensitive to seasonal differences. Minute by minute patterning of GPS and physical activity data is feasible and may be a useful tool to investigate environmental influences on children’s physical activity and to identify opportunities for intervention.

DeBock F, Menze J, Becker S, Litaker D, Fischer J, Seidel I. (Apr 2010). Combining Accelerometry and Heart Rate for Assessing Preschoolers’ Physical Activity. Med Sci Sports Exerc  [Epub ahead of print].

PURPOSE: With rising obesity and rapidly decreasing levels of physical activity (PA) in young children, accurate PA measurement is needed for early screening and intervention evaluation. Although the combination of accelerometry (ACC) with heart rate (HR) recordings is accurate in assessing PA intensity in older children, its utility in correctly classifying PA in preschoolers is unknown. METHODS:: Thirty-three children (64% boys) were recruited from four German preschools. Data included direct observation and Actiheart (CamNtech, Cambridge, UK) monitoring during 2.5 +/-0.7 hours (derivation data) and 1.5 +/-0.3 hours (validation data). Observers assessed PA using the Children’s Activity Rating Scale (CARS). Moderate-to-vigorous PA (MVPA) was defined by CARS scores 4 or 5, with sedentary behavior (SB) 1 or 2. Actiheart recordings were linked to CARS level, with means and 95% confidence intervals calculated for ACC and HR at each observed CARS-level and for MVPA/SB. Using Receiver Operating Characteristic (ROC)-analysis, gender-specific ACC and HR cut-offs for correctly classifying MVPA and SB were first determined in a derivation data set and then tested in a separate validation data set of observations. RESULTS:: By combining HR and ACC cut-offs, 91% and 87% of the 15-second intervals observed as MVPA were correctly classified in girls and boys, respectively. Although generally lower, correct classification rates for SB were highest when only ACC cut-offs were applied (69% for girls, 67% for boys), rather than when combined cut-offs were used. CONCLUSION:: Devices that combine HR and ACC data yield an accurate classification of MVPA in preschoolers, but perform less well for classifying SB. These differences underscore the need to match evaluation methods with the objectives of future PA interventions.

Epstein DH, Preston KL. (Aug 2010). Daily life hour by hour, with and without cocaine: an ecological momentary assessment study. Psychopharmacology (Berl), 211(2), 223-32.

RATIONALE: Effects of an intervention cannot be understood without precise knowledge of the baseline behavior on which the intervention is superimposed. For misusers of illicit drugs, patterns of daily activities and moods have not been studied in a way that is amenable to statistical aggregation. OBJECTIVE: The aim of the study was to compare hour-by-hour daily activities in cocaine-dependent outpatients during urine-verified periods of use and abstinence. METHODS: In a cohort design, a volunteer sample of 112 methadone-maintained cocaine- and heroin-abusing outpatients provided ecological momentary assessment (EMA) data on handheld computers for 10,781 person-days. EMA responses to questions about current location, activities, companions, moods, and recent exposure to putative drug-use triggers were compared across periods of use and abstinence using SAS Proc Glimmix (for binary outcomes) and Proc Mixed (for continuous outcomes). RESULTS: Periods of cocaine use were associated with idle, solitary, affectively negative afternoons but, unexpectedly, were also associated with a greater likelihood of early-morning or late-evening work. The whole-day concomitants of cocaine use were often distinct from the acute predecessors of use seen in prior analyses from the same sample. Several measures of negative mood increased during abstinence. CONCLUSIONS: Weeks of cocaine use and abstinence in outpatients are associated with distinct patterns of mood and behavior; the detailed hourly data reported here should help inform treatment interventions aimed at changing daily activities. The findings also argue against the contention that cocaine abstinence symptoms decrease monotonically from the day of cessation.

Epstein DH, Marrone GF, Heishman SJ, Schmittner J, Preston KL. (Apr 2010). Tobacco, cocaine, and heroin: Craving and use during daily life. Addictive Behaviors, 35(4), 318-324.

Background: Relationships among tobacco smoking, tobacco craving, and other drug use and craving may have treatment implications in polydrug-dependent individuals. Methods: We conducted the first ecological momentary assessment (EMA) study to investigate how smoking is related to other drug use and craving during daily life. For up to 20 weeks, 106 methadone-maintained outpatients carried Palm Pilots (PDAs). They reported their craving, mood, behaviors, environment, and cigarette-smoking status in 2 to 5 random-prompt entries/day and initiated PDA entries when they used cocaine or heroin or had a discrete episode of craving for cocaine or heroin. Results: Smoking frequency increased linearly with random-prompt ratings of tobacco craving, cocaine craving, and craving for both cocaine and heroin. Smoking frequency was greater during discrete episodes of cocaine use and craving than during random-prompt reports of low craving for cocaine. This pattern was also significant for dual cocaine and heroin use and craving. Smoking and tobacco craving were each considerably reduced during periods of urine-verified abstinence from cocaine, and there was a (non significant) tendency for morning smoking to be especially reduced during those periods. Conclusions: This EMA study confirms that smoking and tobacco craving are strongly associated with the use of and craving for cocaine and heroin. Together with prior findings, our data suggest that tobacco and cocaine may each increase craving for (and likelihood of continued use of) themselves and each other. Treatment for tobacco dependence should probably be offered concurrently with (rather than only after) initiation of treatment for other substance-use disorders.

Ernst ME, Sezate GS, Lin W, Weber CA, Dawson JD, Carter BL, Bergus GR. (Jun 2010). Indication-specific 6-h systolic blood pressure thresholds can approximate 24-h determination of blood pressure control.  J Hum Hypertens  [Epub ahead of print].

Ambulatory blood pressure monitoring (ABPM) is an accurate method for evaluating hypertension, yet its use in clinical practice may be limited by availability, cost and patient inconvenience. The objective of this study was to investigate the ability of a 6-h ABPM window to predict blood pressure control, judging by that of the full 24-h ABPM session across several clinical indications in a cohort of 486 patients referred for ABPM. Sensitivities and specificities of the 6-h systolic blood pressure mean to accurately classify patients as hypertensive were determined using a fixed reference point of 130 mm Hg for the 24-h mean. For four common indications, in which ABPM was ordered, prediction tables were constructed varying the thresholds for the 6-h mean to find the optimal value that best predicted the 24-h hypertensive status as determined from the full 24-h interval. Using a threshold of 137 mm Hg for the indications of borderline hypertension, evaluation of current antihypertensive regimen and suspected white-coat hypertension, sensitivity and specificity ranged from 0.83-0.88 to 0.80-0.88, respectively, for the ability of 6-h ABPM to correctly categorize hypertensive status. Using 133 mm Hg as the threshold for treatment resistance resulted in a sensitivity and specificity of 0.93 and 0.83, respectively. We conclude that a shortened ABPM session of 6 h can be used to accurately classify blood pressure as controlled or not, based on the results of a 24-h session. The optimal 6-h threshold for comparison depends upon indication for referral.

Favela J, Tentori M, Gonzalez VM. (May 2010). Ecological validity and pervasiveness in the evaluation of ubiquitous computing technologies for health care. International Journal of Human-Computer Interaction, 26(5), 414-444.

The difficulties associated with the evaluation of ubiquitous computing (Ubicomp) technologies increase in application domains such as hospitals, where human life can be at risk, privacy of personal records is paramount, and labor is costly and highly distributed across space and time. For the last 6 years numerous Ubicomp technologies in support of hospital work have been created and pilot-tested. In this article, the lessons learned from these evaluations are discussed, using two criteria to classify them. The first criterion is ecological validity, namely, the extent to which the evaluation is conducted under realistic conditions. Alternatives range from controlled experiments to in situ evaluations. The article argues in particular for the advantages of intermediate approaches, which is referred to as in silico and in replica. The second criterion relates to the degree of integration of the technology with the environment, which is referred to as its pervasiveness. The evaluation grid that comes out of this exercise highlights the importance of ecological validity in evaluating ambient computing technology that supports the activities conducted in complex health care settings such as hospitals. This provides a framework for evaluating Ubihealth, which can be used to select appropriate techniques as a function of the technological and environmental complexity as well as to devise novel evaluation techniques.

Finan PH, Zautra AJ, Davis MC, Lemery-Chalfant K, Covault J, Tennen H. (May 2010). ‘Genetic influences on the dynamics of pain and affect in fibromyalgia’: Correction to Finan et al. (2010). Health Psychology, 29(3), 245. [Erratum/Correction]

Reports an error in “Genetic influences on the dynamics of pain and affect in fibromyalgia” by Patrick H. Finan, Alex J. Zautra, Mary C. Davis, Kathryn Lemery–Chalfant, Jonathan Covault and Howard Tennen (Health Psychology, 2010[Mar], Vol 29[2], 134-142). In the article, grant information was omitted from the author note. The authors wish to acknowledge grant support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR046034: Alex J. Zautra, PI). (The following abstract of the original article appeared in record 2010-04888-006.) Objective: The purpose of the present investigation was to determine if variation in the catechol- O-methyltransferase (COMT) and mu-opioid receptor (OPRM1) genes is associated with pain-related positive affective regulation in fibromyalgia (FM). Design: Forty-six female patients with FM completed an electronic diary that included daily assessments of positive affect and pain. Between- and within-person analyses were conducted with multilevel modeling. Main Outcome Measure: Daily positive affect was the primary outcome measure. Results: Analyses revealed a significant gene × experience interaction for COMT, such that individuals with met/met genotype experienced a greater decline in positive affect on days when pain was elevated than did either val/met or val/val individuals. This finding supports a role for catecholamines in positive affective reactivity to FM pain. A gene × experience interaction for OPRM1 also emerged, indicating that individuals with at least one asp⁴⁰ allele maintained greater positive affect despite elevations in daily pain than those homozygous for the asn⁴⁰ allele. This finding may be explained by the asp⁴⁰ allele’s role in reward processing. Conclusions: Together, the findings offer researchers ample reason to further investigate the contribution of the catecholamine and opioid systems, and their associated genomic variants, to the still poorly understood experience of FM.

Fisher RS. (Apr 2010). Tracking epilepsy with an electronic diary.  Acta Paediatrica, Vol 99(4), 516-518.

A diagnosis of epilepsy depends upon an experienced clinician attaining a history of episodes that sound like recurrent spontaneous seizures. Tests such as EEG, MRI and blood tests are adjunctive, but not in themselves definitive in the absence of a compelling clinical history. Unfortunately, seizure histories often are lacking in several regards. Many people who have a seizure do not know or forget that they did so. Finally, many patients and parents keep poor records of seizures. This record-keeping problem should be soluble with better education and modern technology. is the website of the Epilepsy Therapy Project, and it represents the most visited website in the world for people with epilepsy, achieving about 250,000 unique visitors per month. Users can enter the number of seizures per day by seizure type. For up to five seizures per day, they can specify time of day and seizure duration. Users have the opportunity to rank their mood, to add free-text comments, or to attach files, such as videos of the seizure. After thousands of users have entered data longitudinally into the diary, it will become possible to make observations on patterns. Although I have oriented this to seizures, an electronic diary should be easily modified for other recurrent disturbances, such as headaches and asthma episodes.

Fleeson W, Wilt J. (Jun 2010). The Relevance of Big Five Trait Content in Behavior to Subjective Authenticity: Do High Levels of Within-Person Behavioral Variability Undermine or Enable Authenticity Achievement? J Pers [Epub ahead of print].

Individuals vary their behavior from moment to moment a great deal, often acting “out of character” for their traits. This article investigates the consequences for authenticity. We compared 2 hypotheses-trait consistency, that individuals feel most authentic when acting in a way consistent with their traits; and state-content significance, that some ways of acting feel more authentic because of their content and consequences, regardless of the actor’s corresponding traits. Three studies using experience-sampling methodology in laboratory and natural settings, with participants ages 18-51, strongly supported the state-content significance hypothesis and did not support the trait-consistency hypothesis. Authenticity was consistently associated with acting highly extraverted, agreeable, conscientious, emotionally stable, and intellectual, regardless of the actor’s traits. Discussion focuses on possible implications for within-person variability in behavior and for the nature of the self-concept.

Garrison AM, Kahn JH. (Apr 2010). Intraindividual relations between the intensity and disclosure of daily emotional events: The moderating role of depressive symptoms. Journal of Counseling Psychology, 57(2), 187-197.

Individuals with high levels of depressive symptoms tend to engage in lower levels of emotional disclosure than individuals who are lower in depressive symptoms. However, little is known about how depressive symptoms relate to the intraindividual relation between daily disclosure and the intensity of the daily events. The authors addressed these relations using a daily diary methodology. College students (N = 239) completed a measure of depression symptoms. They then completed measures of the intensity of the day’s most unpleasant event and their disclosure of that event each day for 7 days. Results indicated that depression moderated the intensity–disclosure relation such that depression symptoms were associated with diminished emotional disclosure for high-intensity events but not for low-intensity events. Individuals with relatively higher levels of depressive symptoms also experienced unpleasant daily events at a higher intensity level than did individuals with relatively fewer symptoms. Sex differences emerged such that men were less likely than women to disclose high-intensity negative events. These findings extend the use of the diary methodology to the study of emotional disclosure and also suggest possible interventions for counseling psychology practitioners.

Haakstad LA, Gundersen I, Bø K.  (Jun 2010). Self-reporting compared to motion monitor in the measurement of physical activity during pregnancy. Acta Obstet Gynecol Scand, 89(6), 749-56.

Most pregnancy-studies have relied on retrospective, cross-sectional surveys to measure physical activity level. Questionnaires are cost-effective, but validity of the data may be questionable. OBJECTIVE: The aim of the present study was to validate a physical activity and pregnancy questionnaire (PAPQ) with a portable activity monitor (ActiReg). DESIGN: Prospective comparison study. SETTING: Healthy pregnant women recruited in a capital area. POPULATION: Seventy-seven pregnant women wore the ActiReg sensors during waking hours for seven consecutive days and answered the PAPQ. MAIN OUTCOME MEASURES: Agreement between the two methods was analyzed by Bland-Altman plots and Spearman correlation coefficients. RESULTS: The results indicated only small differences between the PAPQ and the ActiReg((R)) in cross-tabulation of total physical activity level and proportion of participants meeting the current exercise guidelines. The correlation between the methods was good (r = 0.59) for time spent in activities with high intensity (METS > 6), moderate for time spent standing/moving (r = 0.36) and fair for sitting/lying (r = 0.29). The Bland-Altman plot of the activity patterns, showed a mean difference near zero with no apparent trends and wide scatter of individual observations. CONCLUSIONS: The PAPQ may be considered an acceptable method for assessing habitual physical activity and exercise among pregnant women at group level. However, as questionnaires and portable activity monitors have their strengths in measuring different aspects of physical activity, there may be advantages in combining these two types of instruments for registrations of physical activity level during pregnancy.

Hachizuka M, Yoshiuchi K, Yamamoto Y, Iwase S, Nakagawa K, Kawagoe K, Akabayashi A. (May 2010). Development of a Personal Digital Assistant (PDA) System To Collect Symptom Information from Home Hospice Patients. J Palliat Med  [Epub ahead of print].

Purpose: Previous studies have found that inappropriate assessment of cancer pain can lead to inadequate pain management. To improve assessment, it may be helpful to collect real-time data in a natural environment using computerized ecological momentary assessment (cEMA). Therefore, the aim of the study was to develop a personal digital assistant (PDA) system to collect information on symptoms such as pain and mood states in patients with cancer using cEMA. Methods: Following a pilot study in inpatients with cancer, the second phase of the study involved patients with terminal cancer receiving home hospice care. These patients were asked to record their symptoms in a PDA (a palm-sized portable device) several times per day for a week when they took rescue medications and when an alarm sounded. At the end of the week, an interview on the usability of the device was conducted and overall response rates were calculated. Results: Fifteen patients completed the second phase of the study. Their median age was 64 years and the median survival time after the study period was 22 days. The overall response rates were 90.3% to the sound of the alarm and 80.2% after taking rescue medications. The user-friendliness of the device was rated as 8.8 on a scale of 0 (worst) to 10 (best). Conclusions: The cEMA technique using a PDA might be applicable to patients with cancer in palliative care to evaluate symptoms in a natural setting. This system may also be useful for managing symptoms such as pain and mood states in patients with cancer.

Hallal PC, Simoes E, Reichert FF, Azevedo MR, Ramos LR, Pratt M, Brownson RC. (May 2010) Validity and reliability of the telephone-administered international physical activity questionnaire in Brazil. J Phys Act Health, 7(3), 402-9.

PURPOSE: To evaluate the validity and reliability of the telephone-administered long IPAQ version. METHODS: The questionnaire was administered by telephone to adults on days 1 and 6. On day 1, the same questionnaire was administered by face-to-face interview, and accelerometers were delivered to subjects. Reliability was measured by comparing data collected using the telephone questionnaire on days 1 and 6. Validity was measured by comparing the telephone questionnaire data with (a) face-to-face questionnaire and (b) accelerometry. RESULTS: Data from all instruments were available for 156 individuals. The Spearman correlation coefficient for telephone interview reliability was 0.92 for the leisure-time section of IPAQ, and 0.87 for the transport-related section of IPAQ. The telephone interview reliability kappa was 0.78. The Spearman correlation between the telephone-administered and the face-to-face questionnaire was 0.94 for the leisure-time and 0.82 for the transport-related section. The kappa was 0.69. There was a positive association between quartiles of accelerometer data and total telephone-administered IPAQ score (P < .001). The Spearman correlation was 0.22. CONCLUSIONS: The telephone-administered IPAQ presented almost perfect reliability and very high agreement with the face-to-face version. The agreement with accelerometer data were fair for the continuous score, but moderate for the categorical physical activity variables.

Havermans R, Nicolson NA, Berkhof J, Devries MW. (May 2010). Mood reactivity to daily events in patients with remitted bipolar disorder. Psychiatry Res [Epub ahead of print].

Information about mood reactions to naturally occurring stress in remitted bipolar patients may help elucidate the mechanism by which stressors influence the propensity to manic or depressive relapse in these patients. Using the experience sampling method (ESM), we therefore investigated negative and positive mood states and their reactivity to daily hassles and uplifts in 38 outpatients with remitted bipolar disorder and 38 healthy volunteers. Multilevel regression analyses confirmed that mean levels of negative affect (NA) were higher and positive affect (PA) lower in bipolar patients. Reactivity of NA and PA to hassles and uplifts in bipolar patients was similar to controls and was unrelated to the number of previous episodes. Bipolar patients with subsyndromal depressive symptoms, however, showed particularly large NA responses to daily hassles, which they also rated as more stressful. Subsyndromal depressive symptoms in patients with remitted bipolar disorder thus appear to increase sensitivity to everyday stressors.

Henry BL, Minassian A, Young JW, Paulus MP, Geyer MA, Perry W. (Apr 2010). Cross-species assessments of motor and exploratory behavior related to bipolar disorder. Neurosci Biobehav Rev [Epub ahead of print].

Alterations in exploratory behavior are a fundamental feature of bipolar mania, typically characterized as motor hyperactivity and increased goal-directed behavior in response to environmental cues. In contrast, abnormal exploration associated with schizophrenia and depression can manifest as prominent withdrawal, limited motor activity, and inattention to the environment. While motor abnormalities are cited frequently as clinical manifestations of these disorders, relatively few empirical studies have quantified human exploratory behavior. This article reviews the literature characterizing motor and exploratory behavior associated with bipolar disorder and genetic and pharmacological animal models of the illness. Despite sophisticated assessment of exploratory behavior in rodents, objective quantification of human motor activity has been limited primarily to actigraphy studies with poor cross-species translational value. Furthermore, symptoms that reflect the cardinal features of bipolar disorder have proven difficult to establish in putative animal models of this illness. Recently, however, novel tools such as the human behavioral pattern monitor provide multivariate translational measures of motor and exploratory activity, enabling improved understanding of the neurobiology underlying psychiatric disorders.

Hong RY. (Jun 2010). Neuroticism, anxiety sensitivity thoughts, and anxiety symptomatology: Insights from an experience-sampling approach. Cognitive Therapy and Research, 34(3), 254-262.

Relations among Neuroticism, anxiety sensitivity (AS) thoughts, and anxiety symptoms were examined in this study using an experience-sampling methodology. Daily AS thoughts and anxiety symptoms arising from naturally-occurring negative events were assessed among 100 participants over a 1 month period. Neuroticism moderated the relation between anxiety symptoms and AS thoughts such that individuals high on Neuroticism reported more AS thoughts on days when high (rather than low) anxiety was experienced. Conversely, the relation between anxiety and AS thoughts on a daily basis was weaker for low Neuroticism individuals. Consistent with previous research, elevated levels of AS thoughts on any particular day were associated with increased subsequent anxiety symptoms. The present findings highlight the importance of elucidating psychopathological processes associated with AS and anxiety not only at the interindividual level, but also at the intraindividual level.

Houtveen JH, Hamaker EL, Van Doornen LJ. (May 2010). Using multilevel path analysis in analyzing 24-h ambulatory physiological recordings applied to medically unexplained symptoms. Psychophysiology, 47(3), 570-8.

A non-clinical group high on heterogeneous medically unexplained symptoms (MUS; n=97) was compared with healthy controls (n=66) on the within-subject relationships between physiological measures using multilevel path analysis. Momentary experienced somatic complaints, mood (tension and depression), cardiac autonomic activity (inter-beat intervals, pre-ejection period (PEP), and respiratory sinus arrhythmia (RSA)) and respiration (rate and partial pressure of CO(2) at the end of a normal expiration) were monitored for 24 h using electronic diary and ambulatory devices. Relationships between measures were controlled for diurnal variation and individual means. Only subtle group differences were found in the diurnal rhythm and in the within-subject relationships between physiological measures. For participants high on MUS, within-subject changes in bodily symptoms were related to changes in mood, but only marginally to the physiological measures. Results of the current path analysis confirm the subordinate role of cardiac autonomic and respiratory parameters in MUS.

Huijnen IP, Verbunt JA, Peters ML, Delespaul P, Kindermans HP, Roelofs J, Goossens M, Seelen HA. (May 2010). Do depression and pain intensity interfere with physical activity in daily life in patients with Chronic Low Back Pain? Pain [Epub ahead of print].

Patients with chronic pain may have difficulties estimating their own physical activity level in daily life. Pain-related factors such as depression and pain intensity may affect a patients’ ability to estimate their own daily life activity level. This study evaluates whether patients with Chronic Low Back Pain (CLBP) who are more depressed and/or report more pain indeed have a lower objectively assessed daily life activity level or whether they only perceive their activity level as lower. Patients with CLBP were included in a cross-sectional study. During 14days physical activity in daily life was measured, with both an electronic diary and an accelerometer. Multilevel analyses were performed to evaluate whether a higher level of depression and/or pain intensity was associated with a lower objectively assessed activity level or the discrepancy between the self-reported and objectively assessed daily life activity levels. Results, based on 66 patients with CLBP (mean RDQ score 11.8), showed that the objectively assessed daily life activity level is not associated with depression or pain intensity. There was a moderate association between the self-reported and objectively assessed activity levels (beta=0.39, p<0.01). The discrepancy between the two was significantly and negatively related to depression (beta=-0.19, p=0.01), indicating that patients who had higher levels of depression judged their own activity level to be relatively low compared to their objectively assessed activity level. Pain intensity was not associated with the perception of a patient’s activity level (beta=0.12, ns).

Husky MM, Gindre C, Mazure CM, Brebant C, Nolen-Hoeksema S, Sanacora G, Swendsen J. (May 2010). Computerized ambulatory monitoring in mood disorders: Feasibility, compliance, and reactivity. Psychiatry Res [Epub ahead of print].

Patients with depression (n=20) or bipolar disorder (n=21) completed computerized ambulatory monitoring for three consecutive days. Results indicate satisfactory rates of acceptance and compliance, with no salient fatigue effects. However, some evidence for reactive effects was found. The findings provide support for this approach in the study of mood disorders.

Ilies R, Dimotakis N, De Pater IE.  (Jul 2010). A comparison of retrospective self-report versus ecological momentary assessment measures of affective lability in the examination of its relationship with bulimic symptomatology. Personnel Psychology, 63(2), 407-436.

We report a field study examining within-individual effects of workload on distress at work and daily well-being. The study was conducted using experience-sampling methodology to measure daily workload, affective distress, and blood pressure throughout and at the end of each of 10 workdays, and emotional burnout and daily strain (two indicators of low well-being) during the evening in a sample of 64 full-time employees who provided a total of 354 person-day data points. We also measured employees job control and perceived organizational support with a separate survey. Results showed that workload was positively associated with affective distress and blood pressure, and with the indicators of low daily well-being. Furthermore, affective distress mediated the relationship between workload and daily well-being. More importantly, job control and organizational support had cross-level moderating influences on the relationships of workload with affective distress and blood pressure such that these relationships were weaker for participants who reported having more control on their job, as well as for participants who reported receiving more organizational support.

Ilott N, Saudino KJ, Wood A, Asherson P. (Apr 2010). A genetic study of ADHD and activity level in infancy. Genes, Brain & Behavior,  9(3), 296-304.

It is well known that there are strong genetic influences on attention-deficit hyperactivity disorder (ADHD), with genetic association studies providing good evidence for the involvement of the dopamine neurotransmitter system in its aetiology. Developmental origins of ADHD represent an interesting area of research to understand the genetics that underlie early appearing individual differences. However, understanding the molecular basis of ADHD requires accurate, unbiased, heritable measures that can be used for molecular genetic association analyses. We take two approaches to examine the genetics of ADHD behaviours in infancy. Using quantitative genetic techniques, we explore the relationship between objective measures of activity level (AL) in both home and laboratory environments as well as with parent ratings of ADHD symptoms in a population sample of 2-year-old twins. Molecular association analyses of these measures examine candidate genes previously associated with ADHD. We find that ADHD symptoms, AL in the home and AL in the lab represent heritable phenotypes in 2-year-old infants. AL measured in the home has a strong genetic correlation with symptoms of ADHD, whereas AL in the lab correlates only modestly with the same ADHD measure. Genetic correlations suggest that AL in the home is more comparable than AL in the lab to ADHD behaviour and support the separation of all three for molecular analyses. There was modest evidence for association between DAT1, NET1 and ADHD symptom scores, as well as between DAT1 and AL in the lab.

Kashdan TB, Collins RL. (May 2010). Social anxiety and the experience of positive emotion and anger in everyday life: an ecological momentary assessment approach. Anxiety Stress Coping, 23(3), 259-72.

A few recent studies have found evidence showing that social anxiety is associated with diminished positive affect and elevated anger. However, prior work has relied on trait self-report measures of global positive mood or anger. In this preliminary study, we examined how trait social anxiety relates to moment-to-moment positive and angry emotional states as people navigate through their natural environment in a given day. Of additional interest was whether any associations were limited to social situations or were evident more broadly in non-social situations as well. For 14 days, 38 non-clinical community adults carried electronic diaries to assess their experience of positive emotions, anger, and their current social context and activity. Participants were randomly prompted up to four times per day, leading to 1702 observations. Results showed that social anxiety was associated with less time spent feeling happy and relaxed and more time spent feeling angry throughout the day. In general, people felt happier when they were with other people compared to being alone. Interestingly, people with relatively higher levels of social anxiety reported fewer and less intense positive emotions and greater anger episodes across social and non-social situations.

Lamont A, Webb R. (Apr 2010). Short- and long-term musical preferences: What makes a favourite piece of music? Psychology of Music, 38(2), 222-241.

Within the growing field of music preferences, little is currently known about the concept of a favourite piece of music. The current study explores listeners’ nominated favourite pieces of music over short and longer time-spans, combining diary and interview methods to uncover what a favourite means, how stable it is, and what factors influence the development of favourites. Nine undergraduate students participated in a diary study spanning one month, with follow-up interviews conducted with two participants. Results indicate that musical favourites are subject to rapid change and highly context-dependent. Most daily favourites were heard on the day, either deliberately or by chance. ‘Magpie’ listeners collected a large number of relatively transient favourites, while ‘squirrel’ listeners had a large catalogue of music stored from which to select. Long-term favourites differed from daily favourites, being associated with intense emotional events in listeners’ lives. In this small-scale study, diary methods successfully captured fluctuations in music preferences over time for most listeners, while interviews revealed more about listeners’ motivations and personal stories connected with their favourite music. Future research is required with larger samples to tease out the complexities of developing music preferences over time and engagement with music in everyday life settings.

Lee CM, Patrick ME, Neighbors C, Lewis MA, Tollison SJ, Larimer ME. (Aug 2010). Exploring the role of positive and negative consequences in understanding perceptions and evaluations of individual drinking events.  Addictive Behaviors, 35(8), 764-770.

While research has established that drinking more alcohol is associated with experiencing more positive and negative alcohol-related consequences, less is known about how college students evaluate their drinking experiences. Evaluations of drinking events may vary with factors such as how much one drinks, which consequences one experiences, and the context (i.e., where and with whom) one drinks on a given occasion. This research used daily data (Level 2: N = 166 students, 61% female; Level 1: N = 848 person drinking days) to explore the relationship between quantity of alcohol consumed and experience of specific domains of positive and negative consequences and to examine how the experience of specific consequences related to overall evaluation of the drinking experience. Drinking on a given day was positively associated with experiencing more negative (social and personal) and more positive (image, fun/social, and relaxation) consequences. With respect to the formation of overall impressions, negative (social and personal) consequences were associated with less favorable evaluations whereas positive (image, fun/social, and relaxation) consequences were associated with more favorable evaluations of the drinking experience. Indirect effects analyses suggested that consequences (negative personal, negative social, positive fun/social, and positive relaxation) significantly mediated the relationship between drinking and overall evaluation at the daily level. These results underscore the importance of considering both positive and negative consequences in understanding students’ choices to drink and how they evaluate their experiences.

Machado-Rodrigues AM, Figueiredo AJ, Mota J, Cumming SP, Eisenmann JC, Malina RM, Coelho-E-Silva MJ. (Jun 2010). Concurrent validation of estimated activity energy expenditure using a 3-day diary and accelerometry in adolescents. Scand J Med Sci Sports  [Epub ahead of print].

Estimates of daily energy expenditure are important to studies of physical activity and energy balance. Objective measures are not always feasible and further research is needed to validate survey instruments and diaries. The study validates estimated activity energy expenditure (AEE) based on a 3-day diary protocol relative to AEE derived from uniaxial accelerometry in adolescents, 265 girls and 227 boys (12.5-16.4 years). Participants completed the diary and wore a GT1M Actigraph accelerometer on the same days. Height and weight were measured. Correlations between protocols were significant (P<0.001) but moderate, r=0.65 in males and r=0.69 in females. The highest correlation occurred among males on Friday, r=0.74 (P<0.01). Controlling for body mass, partial correlations between protocols decreased to 0.44 and 0.35 in males and females, respectively. About 97% of the cases fell within the limits of agreement in a Bland-Altman plot. The criterion of inclusion for the accelerometer excluded 18% of the initial sample. In summary, the 3-day diary was completed without any major problems and provided a reasonably valid alternative for assessing AEE. Concordance between methods was slightly lower for individuals with higher values of AEE.

Marceau LD, Link CL, Smith LD, Carolan SJ, Jamison RN. (Jun 2010). In-Clinic Use of Electronic Pain Diaries: Barriers of Implementation Among Pain Physicians. J Pain Symptom Manage [Epub ahead of print].

OBJECTIVE: The aim of this study was to examine barriers to the use of electronic diaries within the clinic setting and determine outcome differences between patients who used electronic diaries to monitor their progress with summary data feedback and patients who monitored their progress with paper diaries without summary data feedback. METHODS: One hundred thirty-four (n=134) chronic pain patients were asked to monitor their pain, mood, activity interference, medication use, and pain location on either a paper or electronic diary immediately before each monthly clinic visit for 10 months. Patients and their treating physicians in the electronic diary group (n=67) were able to observe changes in their ratings whereas patients using the paper diaries (n=67) had no feedback about their data entry. RESULTS: Most participants believed that completing pain diaries was beneficial; yet, only 23% of patients in the experimental condition felt that the data from the electronic diaries improved their care and less than 15% believed that their doctor made a change in their treatment based on the summary diary information. CONCLUSION: In general, treating physicians were positive about the use of electronic diaries, although they admitted that they did not regularly incorporate the summary data in their treatment decision making because either they forgot or they were too busy. Future studies in understanding barriers to physicians’ and patients’ use of diary data to impact treatment outcome are needed to improve care for persons with chronic pain.

Miner AG, Glomb TM. (May 2010). State mood, task performance, and behavior at work: A within-persons approach. Organizational Behavior and Human Decision Processes, 112(1), 43-57.

We examine the intra-individual relationships between state mood and the primary components of the individual-level criterion space (task performance, organizational citizenship behavior, and work withdrawal) as they vary within the stream of work. Using experience-sampling methods, 67 individuals in a call center responded to surveys on palmtop computers at random intervals 4–5 times each day for 3 weeks (total N =2329). These data were matched to objective task performance obtained from organizational call records (total N =1191). Within-persons, periods of positive mood were associated with periods of improved task performance (as evidenced by shorter call time) and engaging in work withdrawal. Trait meta-mood moderated these relationships. Specifically, individuals who attended to their moods had a stronger relationship between mood and speed of task performance (call time) and individuals able to repair their mood cognitively evidenced a weaker relationship between mood and withdrawal. Implications and the use of within-persons designs are discussed.

Moe-Nilssen R, Aaslund MK, Hodt-Billington C, Helbostad JL. (May 2010). Gait variability measures may represent different constructs. Gait Posture, 32(1), 98-101.

Many measures of gait variability have been reported, but the degree to which such measures are associated and thus represent a common construct is inconclusive. The purpose of this paper is to establish construct validity of commonly used spatio-temporal footfall variability and trunk variability measures taking into account the effect of measurement error. Twenty-three older individuals, aged 80+/-5 years performed four repeated walks at preferred speed, 0.97+/-0.16m/s. Gait data were obtained by an electronic walkway and by trunk accelerometry. Of initially 13 variability measures, five satisfied a reliability criterion of ICC> or =0.80 and were included in a subsequent construct validity analysis. Of these, step length variability and step time variability did not correlate significantly, while step length variability correlated closely with anteroposterior interstep trunk variability, and step time variability with vertical interstep trunk variability. Mediolateral interstep trunk variability did not correlate significantly with any of the other measures. This finding supports the notion that this measure may represent still a different aspect of variability. Different gait variability measures representing different constructs should be included in gait analysis to enhance our understanding of variability in gait.

Navarro J, Arrieta C. (May 2010). Chaos in human behavior: The case of work motivation. The Spanish Journal of Psychology, 13(1), 244-256.

This study considers the complex dynamics of work motivation. Forty-eight employees completed a work-motivation diary several times per day over a period of four weeks. The obtained time series were analysed using different methodologies derived from chaos theory (i.e. recurrence plots, Lyapunov exponents, correlation dimension and surrogate data). Results showed chaotic dynamics in 75% of cases. The findings confirm the universality of chaotic behavior within human behavior, challenge some of the underlying assumptions on which work motivation theories are based, and suggest that chaos theory may offer useful and relevant information on how this process is managed within organizations.

Nielsen K, Cleal B. (Apr 2010). Predicting flow at work: Investigating the activities and job characteristics that predict flow states at work. Journal of Occupational Health Psychology, 15(2), 180-190.

Flow (a state of consciousness where people become totally immersed in an activity and enjoy it intensely) has been identified as a desirable state with positive effects for employee well-being and innovation at work. Flow has been studied using both questionnaires and Experience Sampling Method (ESM). In this study, we used a newly developed 9-item flow scale in an ESM study combined with a questionnaire to examine the predictors of flow at two levels: the activities (brainstorming, planning, problem solving and evaluation) associated with transient flow states and the more stable job characteristics (role clarity, influence and cognitive demands). Participants were 58 line managers from two companies in Denmark; a private accountancy firm and a public elder care organization. We found that line managers in elder care experienced flow more often than accountancy line managers, and activities such as planning, problem solving, and evaluation predicted transient flow states. The more stable job characteristics included in this study were not, however, found to predict flow at work.

Nisenbaum R, Links PS, Eynan R, Heisel MJ. (May 2010). Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: multilevel analyses applied to experience sampling methodology. J Abnorm Psychol, 119(2), 433-9.

Variability in mood swings is a characteristic of borderline personality disorder (BPD) and is associated with suicidal behavior. This study investigated patterns of mood variability and whether such patterns could be predicted from demographic and suicide-related psychological risk factors. Eighty-two adults with BPD and histories of recurrent suicidal behavior were recruited from 3 outpatient psychiatric programs in Canada. Experience sampling methodology (ESM) was used to assess negative mood intensity ratings on a visual analogue scale, 6 random times daily, for 21 days. Three-level models estimated variability between times (52.8%), days (22.2%), and patients (25.1%) and supported a quadratic pattern of daily mood variability. Depression scores predicted variability between patients’ initial rating of the day. Average daily mood patterns depended on levels of hopelessness, suicide ideation, and sexual abuse history. Patients reporting moderate to severe sexual abuse and elevated suicide ideation were characterized by worsening moods from early morning up through evening, with little or no relief; patients reporting mild sexual abuse and low suicide ideation reported improved mood throughout the day. These patterns, if replicated in larger ESM studies, may potentially assist the clinician in determining which patients require close monitoring.

Okifuji A, Bradshaw DH, Donaldson GW, Turk DC. (Jun 2010). Sequential Analyses of Daily Symptoms in Women With Fibromyalgia Syndrome. J Pain [Epub ahead of print].

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder characterized by generalized pain, chronic fatigue, sleep disturbance, and a range of other symptoms having no definitive pathology. Consequently, patient evaluations rely on self-report. Ecological Momentary Assessment (EMA) allows frequent real-time collection of self-report measures, removing recall bias and increasing external validity. We studied 81 females with FMS aged 18 to 42 years. Participants carried EMA devices (Palm Pilot M100) programmed to request ratings to 8 FMS symptoms/conditions 3 times daily for 30 days. Completeness of response rates varied across participants and over time. Controlling for immediately previous fatigue (ie, fatigue rating from the immediately preceding rating), unit increases in immediately previous pain and immediately previous emotional distress predicted 9 and 7% increases, respectively, in current fatigue. Controlling for immediately previous emotional distress, a unit increase in immediately previous pain predicted 7% increase in current emotional distress. Controlled for immediately previous pain, a unit increase in immediately previous fatigue predicted a 7% increase in current pain, enhanced by prior diurnal effects; immediately previous emotional distress was not significant. Collectively these results suggest an asymmetry in which emotional stress and pain may increase fatigue, fatigue but not emotional distress may increase pain, and pain but not fatigue may increase emotional distress. Despite small effects and person-to-person variability, these findings suggest that longitudinal data collection by EMA may reveal sequential or causal explanatory patterns with important clinical implications. PERSPECTIVE: Understanding how multiple symptoms covary in FMS is essential for optimal treatment planning. Our results show that small but significant temporal relations among pain, fatigue, and emotional distress. Our results also provide support for the use of EMA as a viable data collection method that allows longitudinal, real-time assessment of multiple FMS symptoms.

Pfaltz MC, Grossman P, Michael T, Margraf J, Wilhelm FH.  (May 2010). Physical activity and respiratory behavior in daily life of patients with panic disorder and healthy controls. Int J Psychophysiol [Epub ahead of print].

Panic disorder (PD) has been linked in laboratory investigations to respiratory alterations, particularly persistent respiratory variability. However, studies of PD respiratory pattern outside the laboratory are rare, have not controlled for the confounding influence of varying levels of physical activity, and have not addressed whether abnormalities in respiratory pattern vary depending on the intensity of physical activity. Cognitive and biological theories of PD, in fact, predict that respiratory alterations may be particularly pronounced when patients are physically active. This study assessed physical activity and respiratory pattern of 26 PD patients and 26 healthy controls (HC) during two waking periods of daily life (9:00-21:00) one week apart. Respiratory data were stratified for predefined levels of physical activity (inactivity, minimal movement, slow/moderate/fast walking, and running) and analyzed using linear mixed models. Groups did not generally differ in respiratory measures, although PD patients did show elevated variability of absolute levels of tidal volume during minimal movement and slow walking (root mean squared successive differences). Other ways of analyzing tidal volume variability based on relative levels, percentage of sighing, or pooled activity levels did not substantiate this finding. Amount of time spent at different activity levels did not differ between groups, which is at variance with studies linking anticipatory anxiety with motoric agitation, and PD with self-reported avoidance of exercise. In conclusion, results provided little evidence for respiratory abnormalities or central respiratory dysregulation in PD at varying levels of activity, although instability of tidal volume regulation during low activity remains a possibility. Our research approach indicates that the usefulness of stratification of real life data on the basis of levels of activity, as well as how ambulatory assessment strategies, complementarily to laboratory studies, may improve understanding of biological and psychological factors contributing to development and maintenance of PD and other anxiety disorders.

Ritz T, Rosenfield D, Steptoe A. (May 2010). Physical activity, lung function, and shortness of breath in daily life of individuals with asthma. Chest [Epub ahead of print].

BACKGROUND: The effects of physical activity on asthma have been explored extensively. Exercise can trigger later bronchoconstriction in many patients and deconditioning due to a sedentary life style may be the consequence. However, the immediate effect of physical activity in asthma and health is a bronchodilation. To date little is known about the association between physical activity and lung function in daily life of asthma patients. METHOD: We studied 20 asthmatic individuals and 20 controls using an electronic diary of activities and spirometry (peak expiratory flow, PEF; forced expiratory volume in the first second, FEV(1)). Participants rated their shortness of breath and their intensity of physical and social activity for the preceding 30min. Assessments were made over the course of three weeks three times daily (morning, afternoon, evening/night). RESULTS: Stronger physical activity was concurrently associated with significantly higher lung function. In contrast, it also showed a positive concurrent association with shortness of breath. In prospective cross-lag analyses, lower PEF and FEV(1) earlier in the day predicted lower physical and social activity levels later in the day, but shortness of breath did not. CONCLUSION: The findings show that detrimental effects observed in exercise-induced bronchoconstriction cannot be generalized to physical activity in daily lives of individuals with asthma. Nevertheless, asthmatics still feel more shortness of breath when being more physically active. They adjust their activity levels throughout the day according to their earlier lung function, but this does not fully explain the concurrent positive association of physical activity and lung function.

Sejdic E, Falk TH, Steele CM, Chau T. (May 2010). Vocalization removal for improved automatic segmentation of dual-axis swallowing accelerometry signals.  Med Eng Phys [Epub ahead of print].

Automatic segmentation of dual-axis swallowing accelerometry signals can be severely affected by strong vocalizations. In this paper, a method based on periodicity detection is proposed to detect and remove such vocalizations. Periodic signal components are detected using conventional speech processing techniques and information from both axes are combined to improve vocalization detection accuracy. Experiments with 408 healthy subjects performing dry, wet, and wet chin tuck swallows show that the proposed method attains an average 95.3% sensitivity and 96.3% specificity. When applied in conjunction with an automatic segmentation algorithm, it is observed that segmentation accuracy improves by approximately 55%. These results encourage further development of medical devices for the detection of swallowing difficulties.

Sinadinovic K, Berman AH, Hasson D, Wennberg P. (May 2010). Internet-based assessment and self-monitoring of problematic alcohol and drug use. Addict Behav, 35(5), 464-70.

A Swedish web-based service ( offers self-assessment and self-monitoring of alcohol and drug use via on-line screening with the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) as well as in-depth risk assessment using extended versions of both tests (Alcohol-E and DUDIT-E). Users receive individualized feedback concerning their alcohol and drug consumption and can follow their alcohol and drug use over time in personal diagrams and by writing in an electronic diary. This study describes user characteristics, service utilization patterns, and psychometric test properties for 2361 individuals who created a valid account over 20 months starting in February 2007. Problematic alcohol use according to AUDIT criteria was indicated for 67.4%, while 46.0% met DUDIT criteria for problematic drug use. Men and women accessed the service equally, with a mean age of 23 years. Internal consistency reliability figures were 0.90 for 1846 first-time AUDIT users and 0.97 for 1211 first-time DUDIT users; among 213 second-time AUDIT users reliability was 0.93, and 0.96 for 97 second-time DUDIT users. Internet-based alcohol and drug monitoring could function as a self-help tool or as a complement to substance abuse treatment.

Smetana JG, Villalobos M, Rogge RD, Tasopoulos-Chan M. (Jul 2010). Keeping secrets from parents: Daily variations among poor, urban adolescents. Journal of Adolescence, 33(2), 321-331.

Daily variations in secrecy with mothers and fathers were examined in 108 poor, urban, diverse middle adolescents (M = 15.16 years, SD = 0.89). Adolescents completed online diaries over 14 days assessing secrecy from parents about school, personal, and multifaceted activities (e.g., staying out late), and bad behavior. Three-level hierarchical linear models indicated that there were significant daily fluctuations in adolescents’ secrecy with mothers and that adolescents kept more secrets from mothers about personal than other activities. Secrecy with mothers also was associated with greater involvement in problem behavior. For both mothers and fathers, secrecy on the current day was associated with greater secrecy on the previous day and with poorer overall relationships (as aggregated across study days) with that parent. Thus, for mothers, secrecy appeared to be associated with both stable factors and daily variations, whereas for fathers, secrecy was associated primarily with stable factors. The results provide a detailed picture of secrecy in diverse adolescents’ everyday lives.

Tahmasian M, Khazaie H, Sepehry AA, Russo MB. (Jun 2010). Ambulatory monitoring of sleep disorders. J Pak Med Assoc, 60(6), 480-7.

BACKGROUND: Behavioural and functional activity monitoring has a long history in sleep research. The term “Actigraphy” refers to methods using computerized wristwatch-size devices (generally placed on the wrist, but also on the ankle or trunk) to record the movement it undergoes. Collected data are displayed on a computer and analyzed for change in rhythm parameters that in turn provide an estimate on wake-sleep parameters (such as total sleep time, percent of time spent asleep, total wake time, percent of time spent awake and the number of awakenings). Actigraphy provides a useful, cost-effective, non-invasive and portable method for assessing specific sleep disorders. The present review is an amalgam of current knowledge with proposed clinical application and for research of actigraph. CONCLUSION: Actigraphy cannot stand alone as a diagnostic tool for all clinical groups. Particularly so with those diagnosed with sleep disorders with significant motility or long catatonic periods of wakefulness during sleep.

Thewissen V, Bentall RP, Oorschot M, Campo JA, van Lierop T, van Os J, Myin-Germeys I. (Jun 2010). Emotions, self-esteem, and paranoid episodes: An experience sampling study. Br J Clin Psychol [Epub ahead of print].

Objectives The evidence to date for a causal role of emotions in the generation of paranoid symptoms is scarce, mainly because of a lack of studies investigating the longitudinal association between emotional processes and paranoia. The primary aim of this study was to investigate whether momentary emotional experiences (anxiety, depression, anger/irritability) and self-esteem predicted the onset and duration of a paranoid episode. We also studied whether levels of emotional experiences and self-esteem were respectively higher and lower during a paranoid episode. Design A 1-week, prospective momentary assessment study. Methods Data were collected using the experience sampling method, a structured self-assessment diary technique. The sample consisted of 158 individuals who ranged across the paranoia continuum. Participants with a psychotic disorder were recruited from in-patient and out-patient mental health services. Participants without psychotic disorder were sampled from the general population. Results Specific aspects of emotional experience were implicated in the onset and persistence of paranoid episodes. Both an increase in anxiety and a decrease in self-esteem predicted the onset of paranoid episodes. Cross-sectionally, paranoid episodes were associated with high levels of all negative emotions and low level of self-esteem. Initial intensity of paranoia and depression was associated with longer, and anger/irritability with shorter duration of paranoid episodes. Conclusions Paranoid delusionality is driven by negative emotions and reductions in self-esteem, rather than serving an immediate defensive function against these emotions and low self-esteem. Clinicians need to be aware of the central role of emotion-related processes and especially self-esteem in paranoid thinking.

Tong EMW. (Apr 2010). Personality influences in appraisal emotion relationships: The role of neuroticism.  Journal of Personality, 78(2), 393-417.

Abstract: Although appraisal theorists have pointed out that appraisal–emotion relationships should vary as a function of personality traits, evidence demonstrating this is limited and inconsistent. To examine this issue, Ecological Momentary Assessment was employed in which undergraduates indicated their negative emotions and appraisals at regular intervals for 2 days in natural contexts. The results revealed that individuals higher in Neuroticism showed more negative appraisal styles than those lower in Neuroticism. More important, higher Neuroticism was associated with stronger appraisal–emotion relationships of 4 negative emotions (anger, sadness, fear, and guilt). These findings imply that Neuroticism affects not only how people appraise their environments but also the reactivity of their negative emotions to appraisals.

Uebel H, Albrecht B, Kirov R, Heise A, Döpfner M, Freisleder FJ, Gerber WD, Günter M, Hässler F, Ose C, Poustka F, Fischer R, Banaschewski T, Rothenberger A. (Jun 2010). What can Actigraphy Add to the Concept of Labschool Design in Clinical Trials? Curr Pharm Des [Epub ahead of print].

Pharmacological intervention with methylphenidate (MPH) is very common and helpful in the treatment of attentiondeficit/ hyperactivity disorder (ADHD). It ameliorates inattention, impulsivity and hyperactivity and improves psychosocial functioning. The core symptoms of ADHD are problematic mainly in demanding structured situations such as in the classroom. It was argued that MPH does not only lead to a decrease of hyperactivity in these situations but may also result in a general dampening of motor activity during non-structured leisure time. Unfortunately, only few clinical trials have investigated this practically important issue and thus it is still a matter of debate. It follows that many parents hesitate to accept psychotropic drugs for their children. To elucidate this problem in the current study, not only overall behavioral ratings (half-day blocks) but also day-long actigraphy was applied during an analogue classroom setting, where structured and non-structured situations alternated over time. Fourty-nine children with ADHD were assessed for treatment effects of once-daily extended-release and twice daily immediate-release methylphenidate (MPH) as well as placebo. Both MPH regimes yielded improved behavioral ratings during morning and afternoon, while actigraphy showed reduced motor activity in structured situations, but not during leisure time. Furthermore, the movement information obtained with actigraphy during structured situations could be differentiated from the one gained with overall behavioral ratings. Thus, while behavioral ratings provide a valid estimate of the overall symptomatology, additional information gathered with actigraphy may help to differentiate the impact of medication on hyperactive movement in different situations during the day. This may reflect a more valid picture of a child’s real life and improve the quality of clinical trials. Thus, both methods may be regarded as complementary for the assessment of drug effects in children with ADHD and should be a standard of further laboratory school protocols in clinical trials.

VanZundert RM, Ferguson SG, Shiffman S, Engels RC. (May 2010). Dynamic effects of self-efficacy on smoking lapses and relapse among adolescents. Health Psychology, 29(3), 246-254.

Objective: The present study examined whether dynamic day-to-day variations in self-efficacy predicted success in quit attempts among daily smoking adolescents. Design: A sample of 149 adolescents recorded their smoking and self-efficacy three times per day during 1 week prior to and 3 weeks after a quit attempt. Main Outcome Measures: The first lapse, second lapse, and relapse after at least 24 hours of abstinence from smoking were the main outcome measures. Results: Self-efficacy was relatively high and moderately variable prior to the first lapse, but decreased and became more variable thereafter. Lower self-efficacy as measured at the lapse assessment significantly increased the risk that a second lapse and relapse would occur. Individual differences in baseline self-efficacy did not predict any of the treatment outcomes. The time-varying analyses, however, showed that lower self-efficacy on a given day predicted the first lapse, the second lapse, and relapse on the succeeding day. Daily concomitant smoking (any smoking on the preceding day) was not significantly related to relapse. Conclusion: The present results emphasize the importance of self-efficacy among adolescents in cessation and highlight the need for dynamic formulations and assessments of adolescents’ self-efficacy and relapse.

Wang N, Redmond S, Ambikairajah E, Celler B, Lovell N. (May 2010). Can Triaxial Accelerometry Accurately Recognize Inclined Walking Terrains? IEEE Trans Biomed Eng  [Epub ahead of print].

The standard method of analysis of body accelerations cannot accurately estimate the energy expenditure (EE) of uphill or downhill walking. The ability to recognize the grade of the walking surface will most likely improve upon the accuracy of the EE estimates for daily physical activities. This paper investigates the benefits of automatic gait analysis approaches including step-by-step gait segmentation and heelstrike recognition of the accelerometry signal in classifying various gradients. Triaxial accelerometry signals were collected from 12 subjects, performing walking on seven different gradient surfaces: (i) 92 m of 0+/- flat ground, (ii) 85 m of section sign2:70+/- inclined ramp, (iii) 24 m of section sign9:86+/- inclined ramp, and (iv) 6 m pitch line of section sign28:03+/- rake of stairway. Validity studies performed on a group of randomly selected healthy subjects showed high agreement scores between the automated heel-strike recognition markers, manual gait annotation markers, and video-based gait segmentation markers. 13 subset features were found using a subset selection search procedure from 57 extracted features which maximize the classification accuracy, performed with a Gaussian Mixture Model (GMM) classifier, as estimated using six-fold cross-validation. An overall walking pattern recognition accuracy of 82.46% was achieved on seven different inclined terrains using the 13 selected features. This system should therefore improve the accuracy of daily EE estimates with accurate measures on terrain inclinations.

Wing YK, Zhang J, Ho CK, Au CT, Li AM. (Jun 2010). Periodic limb movement during sleep is associated with nocturnal hypertension in children. Sleep, 33(6), 759-65.

BACKGROUND: Increasing evidence suggests that blood pressure (BP) is significantly influenced by sleep problems in children, but the association between periodic limb movement during sleep (PLMS) and BP is still unclear. This study aims to compare ambulatory blood pressure (ABP) in children with and without PLMS. METHODS AND RESULTS: A cross-sectional study involving 314 children (mean (SD) age of 10.4 (1.7) years, boys 62.4%). Participants underwent an overnight polysomnographic study and ABP monitoring. Subjects were hypertensive if mean SBP or DBP > 95th percentile and prehypertensive if mean SBP or DBP > 90th percentile of reference. Children with PLMS (n = 17) were at significantly higher risk for nocturnal systolic (adjusted OR (95%CI) = 6.25 [1.87-20.88]) and diastolic (OR (95%CI) = 4.83 [1.66-14.07]) hypertension. However, mean nocturnal BP did not differ between children with and without PLMS. There was a trend for higher daytime BP in patients with PLMS than those children without PLMS (P = 0.084 for systolic BP z score; P = 0.051 for diastolic BP z score; P = 0.067 for systolic prehypertension). There were significant associations between log transformed PLM index and daytime systolic and mean BP z scores (P = 0.03 and 0.033 respectively) as well as that between log transformed PLM related arousal index (PLMSArI) and nocturnal diastolic and mean BP (P = 0.008 and 0.038 respectively). CONCLUSIONS: PLMS was independently associated with a wide range of BP elevations, especially nocturnal indices. Future studies should examine the underlying pathophysiologic mechanisms and effects of PLMS treatment on BP.

Zwartjes D, Heida T, van Vugt J, Geelen J, Veltink P. (May 2010). Ambulatory Monitoring of Activities and Motor Symptoms in Parkinson¿s Disease. IEEE Trans Biomed Eng [Epub ahead of print].

Ambulatory monitoring of motor symptoms in Parkinsons disease (PD) can improve our therapeutic strategies, especially in patients with motor fluctuations. Previously published monitors usually assess only one or a few basic aspects of the cardinal motor symptoms in a laboratory setting. We developed a novel ambulatory monitoring system that provides a complete motor assessment by simultaneously analyzing current motor activity of the patient (e.g. sitting, walking) and the severity of many aspects related to tremor, bradykinesia, and hypokinesia. The monitor consists of a set of four inertial sensors. Validity of our monitor was established in seven healthy controls and six PD patients treated with deep brain stimulation (DBS) of the subthalamic nucleus. Patients were tested at three different levels of DBS treatment. Subjects were monitored while performing different tasks, including motor tests of the Unified Parkinsons Disease Rating Scale (UPDRS). Output of the monitor was compared to simultaneously recorded videos. The monitor proved very accurate in discriminating between several motor activities. Monitor output correlated well with blinded UPDRS ratings during different DBS levels. The combined analysis of motor activity and symptom severity by our PD monitor brings true ambulatory monitoring of a wide variety of motor symptoms one step closer.

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