1
|
Cloos L, Mestdagh M, Vanpaemel W, Ceulemans E, Kuppens P. Measuring Continuous Affect in Daily Life With Intensity Profile Drawings. Assessment 2024:10731911241266286. [PMID: 39138593 DOI: 10.1177/10731911241266286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
We examined continuous affect drawings as innovative measure of affective experiences over time. Intensive longitudinal data often rely on discrete assessments, containing "blind spots" between measurements. With continuous affect drawings participants visually depict their affect fluctuations between assessments. In an experience sampling study, participants (N = 115) rated their momentary positive and negative affect 6 times daily. From the second daily rating on, they additionally drew their positive and negative affect changes and reported affective events between assessments. They received one measurement burst between assessments daily. The strength of the approach is a substantial amount of informational gain (average 7%) over linearly interpolated points between assessments. The additional information was subsequently categorized into positive and negative affect peaks and valleys, each occurring once a day per person on average. The probability of detecting peaks and valleys increased with reported events. The drawings correlated positively with momentary affect scores from the burst. Yet, the drawing predicted the bursts less well suggesting that the momentary ratings may yield different information than the drawings. Although the timing of retrospective drawings is less precise than individual momentary assessments, this method provides a comprehensive understanding of affective experiences between assessments, offering a unique perspective on affect dynamics.
Collapse
|
2
|
Heekerens JB, Schulze L, Enge J, Renneberg B, Roepke S. Increases in negative affective arousal precede lower self-esteem in patients with borderline personality disorder but not in patients with depressive disorders: an experience sampling approach. Borderline Personal Disord Emot Dysregul 2023; 10:29. [PMID: 37784203 PMCID: PMC10546701 DOI: 10.1186/s40479-023-00229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/19/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Instability in self-esteem and instability in affect are core features of borderline personality disorder (BPD). For decades, researchers and theorists have been interested in the temporal dynamics between these constructs. Some hypothesize that changes in affective states should precede changes in self-esteem (Linehan, Cognitive-behavioral treatment of borderline personality disorder. Diagnosis and treatment of mental disorders, 1993), while others suggest that changes in self-esteem should precede changes in affective states (Kernberg, Borderline conditions and pathological narcissism, 1975). METHODS In this study, we investigated the temporal relations between negative affective arousal states and current self-esteem in daily life. Patients with BPD (n = 42) or depressive disorders (DD; n = 40), and non-clinical controls (NCC; n = 40) were assessed every 15 min for 13 h. RESULTS As expected, dynamic structural equation modeling showed higher levels of average daily negative affective arousal and lower levels of average daily self-esteem in the BPD group compared with the NCC group, and scores in the DD group were in-between the BPD and the NCC groups. In line with predictions based on Linehan's (Cognitive-behavioral treatment of borderline personality disorder. Diagnosis and treatment of mental disorders, 1993) model of affective dysregulation in BPD, negative affective arousal (t) and subsequent self-esteem (t+ 1) were significantly linked only in the BPD group, implying that higher negative affective arousal is followed by lower current self-esteem in the next measurement (ca. 15 min later). Importantly, self-esteem (t) and subsequent negative affective arousal (t + 1) were not significantly related (Kernberg, Borderline conditions and pathological narcissism, 1975). CONCLUSIONS Our findings suggest close dynamic temporal relations between affective instability and self-esteem instability in BPD, which highlights the importance of providing patients with means to effectively modulate high negative affective arousal states.
Collapse
Affiliation(s)
- Johannes Bodo Heekerens
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Lars Schulze
- Department of Education and Psychology, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany
| | - Juliane Enge
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Babette Renneberg
- Department of Education and Psychology, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
Limberger MF, Schmiedek F, Santangelo PS, Reichert M, Wieland LM, Berhe O, Meyer-Lindenberg A, Tost H, Ebner-Priemer UW. Assessing affect in adolescents with e-diaries: multilevel confirmatory factor analyses of different factor models. Front Psychol 2023; 14:1061229. [PMID: 37425158 PMCID: PMC10328383 DOI: 10.3389/fpsyg.2023.1061229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
In the last two decades, e-diary studies have gained increasing interest, with a dominant focus on mood and affect. Although requested in current guidelines, psychometric properties are rarely reported, and methodological investigations of factor structure, model fit, and the reliability of mood and affect assessment are limited. We used a seven-day e-diary dataset of 189 adolescent participants (12-17 years). The e-diary affect assessments revealed a considerable portion of within-person variance. The six-factor model showed the best model fit compared to the less complex models. Factor loadings also improved with the complexity of the models. Accordingly, we recommend that future e-diary studies of adolescents use the six-factor model of affect as well as reporting psychometric properties and model fit. For future e-diary scale development, we recommend using a minimum of three items per scale to enable the use of confirmatory multilevel factor analyses.
Collapse
Affiliation(s)
- Matthias F. Limberger
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Florian Schmiedek
- Leibniz Institute for Research and Information in Education (DIPF), Frankfurt, Germany
- IDeA Research Center for Individual Development and Adaptive Education of Children at Risk, Frankfurt, Germany
- Department of Educational Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Philip S. Santangelo
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Behavioural Health Technology Interventions, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, Université du Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Markus Reichert
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of eHealth and Sports Analytics, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany
| | - Lena M. Wieland
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Leibniz Institute for Research and Information in Education (DIPF), Frankfurt, Germany
- IDeA Research Center for Individual Development and Adaptive Education of Children at Risk, Frankfurt, Germany
| | - Oksana Berhe
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ulrich W. Ebner-Priemer
- Mental mHealth Lab, Institute for Sport and Sport Science, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
4
|
Heekerens JB, Gross JJ, Kreibig SD, Wingenfeld K, Roepke S. The temporal dynamics of dissociation: protocol for an ecological momentary assessment and laboratory study in a transdiagnostic sample. BMC Psychol 2023; 11:178. [PMID: 37287088 DOI: 10.1186/s40359-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Dissociation is a ubiquitous clinical phenomenon. Dissociative disorders (DD) are primarily characterized by dissociation, and dissociative states are also a criterion for borderline personality disorder (BPD) and the dissociative subtype of post-traumatic stress disorder (PTSD). Dissociative reactions (e.g., depersonalization/derealization or gaps in awareness/memory) across diagnostic categories are believed to be affect contingent and theorized to serve affect regulation functions. What is not clear, however, is how self-reported affect and physiological reactivity unfold within dissociative episodes. To address this issue, the present project aims to investigate the hypothesis (1) whether self-reported distress (as indicated by arousal, e.g., feeling tense/agitated, and/or valence, e.g., feeling discontent/unwell) and physiological reactivity increase before dissociative episodes and (2) whether self-reported distress and physiological reactivity decrease during and after dissociative episodes in a transdiagnostic sample of patients with DD, BPD, and/or PTSD. METHODS We will use a smartphone application to assess affect and dissociation 12 times per day over the course of one week in everyday life. During this time, heart and respiratory rates will be remotely monitored. Afterwards, participants will report affect and dissociative states eight times in the laboratory before, during, and after the Trier Social Stress Test. During the laboratory task, we will continuously record heart rate, electrodermal activity, and respiratory rate, as well as measure blood pressure and take salivary samples to determine cortisol levels. Our hypotheses will be tested using multilevel structural equation models. Power analyses determined a sample size of 85. DISCUSSION The project will test key predictions of a transdiagnostic model of dissociation based on the idea that dissociative reactions are affect contingent and serve affect regulation functions. This project will not include non-clinical control participants. In addition, the assessment of dissociation is limited to pathological phenomena.
Collapse
Affiliation(s)
- Johannes B Heekerens
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, 12203, Berlin, Germany.
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
| | - Sylvia D Kreibig
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
| | - Katja Wingenfeld
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, 12203, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, 12203, Berlin, Germany
| |
Collapse
|
5
|
Kuppens P, Dejonckheere E, Kalokerinos EK, Koval P. Some Recommendations on the Use of Daily Life Methods in Affective Science. AFFECTIVE SCIENCE 2022; 3:505-515. [PMID: 36046007 DOI: 10.1007/s42761-022-00101-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
Real-world emotions are often more vivid, personally meaningful, and consequential than those evoked in the lab. Therefore, studying emotions in daily life is essential to test theories, discover new phenomena, and understand healthy emotional functioning; in short, to move affective science forward. The past decades have seen a surge of research using daily diary, experience sampling, or ecological momentary assessment methods to study emotional phenomena in daily life. In this paper, we will share some of the insights we have gained from our collective experience applying such daily life methods to study everyday affective processes. We highlight what we see as important considerations and caveats involved in using these methods and formulate recommendations to improve their use in future research. These insights focus on the importance of (i) theory and hypothesis-testing; (ii) measurement; (iii) timescale; and (iv) context, when studying emotions in their natural habitat.
Collapse
Affiliation(s)
| | | | | | - Peter Koval
- KU Leuven, Leuven, Belgium
- University of Melbourne, Melbourne, Australia
| |
Collapse
|
6
|
Peters EM, Dong LY, Thomas T, Khalaj S, Balbuena L, Baetz M, Osgood N, Bowen R. Instability of Suicidal Ideation in Patients Hospitalized for Depression: An Exploratory Study Using Smartphone Ecological Momentary Assessment. Arch Suicide Res 2022; 26:56-69. [PMID: 32654657 DOI: 10.1080/13811118.2020.1783410] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study used ecological momentary assessment (EMA) to explore the correlates of suicidal ideation (SI) instability in patients hospitalized for depression and SI. Thirty-nine adult inpatients were given smartphones with visual analogue scales to rate current depressed mood, anger/irritability, feeling socially connected, and SI three times a day throughout hospitalization. Affective Lability Scales (ALS) were also completed at baseline. SI instability was correlated with SI intensity, depressed mood instability, and social connection instability. Social connection instability was not associated with SI instability after controlling for depressed mood instability. ALS scores were not associated with EMA-derived SI instability. Participants with multiple past suicide attempts experienced greater SI instability. More research examining the clinical significance of SI instability is warranted.
Collapse
|
7
|
Bentley KH, Coppersmith DL, Kleiman EM, Nook EC, Mair P, Millner AJ, Reid-Russell A, Wang SB, Fortgang RG, Stein MB, Beck S, Huffman JC, Nock MK. Do Patterns and Types of Negative Affect During Hospitalization Predict Short-Term Post-Discharge Suicidal Thoughts and Behaviors? AFFECTIVE SCIENCE 2021; 2:484-494. [PMID: 35465415 PMCID: PMC9022604 DOI: 10.1007/s42761-021-00058-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/08/2021] [Indexed: 05/29/2023]
Abstract
We still have little understanding of short-term predictors of suicidal thoughts and behaviors (STBs). Prior research links increased negative affect to STBs, but the vast majority of earlier work is limited by measuring negative affect at one time point and aiming to predict STBs months or years in the future. Recently, intensive longitudinal studies have shown that negative affect is associated with suicidal thoughts over relatively short, clinically useful time periods; however, the specific patterns and types of negative affect that predict STBs remain unclear. Using ecological momentary assessment (EMA) data from psychiatric inpatients hospitalized for suicide risk (N = 83), this study sought to test whether the patterns (means and variability) of two types of negative affect (anxiety/agitation and shame/self-hatred, which were derived from a larger EMA battery) during hospitalization predict STBs in the four weeks after discharge: an extremely high-risk time for suicidal behavior. The mean - but not the variability - of both anxiety/agitation and shame/self-hatred during hospitalization predicted the number of days with suicidal thoughts after discharge. The mean and the variability of shame/self-hatred - but not anxiety/agitation - predicted post-discharge suicide attempt. We discuss implications for assessment and treatment of suicidal individuals and propose key directions for future research.
Collapse
Affiliation(s)
- Kate H. Bentley
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, 6thFloor, Boston, MA 02114 USA
- Department of Psychology, Harvard University, Cambridge, USA
| | | | - Evan M. Kleiman
- Department of Psychology, Harvard University, Cambridge, USA
- Department of Psychology, Rutgers University, Piscataway, USA
| | - Erik C. Nook
- Department of Psychology, Harvard University, Cambridge, USA
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, USA
| | - Alexander J. Millner
- Department of Psychology, Harvard University, Cambridge, USA
- Franciscan Children’s Hospital, Boston, USA
| | | | - Shirley B. Wang
- Department of Psychology, Harvard University, Cambridge, USA
| | | | - Michelle B. Stein
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, 6thFloor, Boston, MA 02114 USA
| | - Stuart Beck
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, 6thFloor, Boston, MA 02114 USA
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, 6thFloor, Boston, MA 02114 USA
| | - Matthew K. Nock
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, 6thFloor, Boston, MA 02114 USA
- Department of Psychology, Harvard University, Cambridge, USA
- Franciscan Children’s Hospital, Boston, USA
| |
Collapse
|
8
|
D'Mello SK, Gruber J. Emotional regularity: associations with personality, psychological health, and occupational outcomes. Cogn Emot 2021; 35:1460-1478. [PMID: 34414862 DOI: 10.1080/02699931.2021.1968797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Emotional regularity is the degree to which a person maintains and returns to a set of emotional states over time. The present investigation examined associations between emotional regularity and extant emotion measures as well as psychologically relevant dimensions of personality, health, and real-world occupational outcomes. Participants included 598 U.S. adults who provided daily experience sampling reports on their emotional states for approximately two months. Results suggest that emotional regularity was related to, but distinct from, well-established measures of emotion including emotional intensity, variability, covariation, inertia, granularity, and emodiversity. Furthermore, emotional regularity significantly predicted measures of personality, psychological health, and occupational outcomes even when accounting for extant emotion measures and sociodemographic covariates. Finally, it explained modest (7.5%) improvement (in terms of cross-validated RSq.) over baseline models containing emotional intensity, variability, and sociodemographic covariates. These findings suggest that emotional regularity may provide an important indicator of healthy emotional functioning and may be a promising area for further scientific discovery.
Collapse
Affiliation(s)
- Sidney K D'Mello
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| |
Collapse
|
9
|
Reichert M, Gan G, Renz M, Braun U, Brüßler S, Timm I, Ma R, Berhe O, Benedyk A, Moldavski A, Schweiger JI, Hennig O, Zidda F, Heim C, Banaschewski T, Tost H, Ebner-Priemer UW, Meyer-Lindenberg A. Ambulatory assessment for precision psychiatry: Foundations, current developments and future avenues. Exp Neurol 2021; 345:113807. [PMID: 34228998 DOI: 10.1016/j.expneurol.2021.113807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 06/18/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
Precision psychiatry stands to benefit from the latest digital technologies for assessment and analyses to tailor treatment towards individuals. Insights into dynamic psychological processes as they unfold in humans' everyday life can critically add value in understanding symptomatology and environmental stressors to provide individualized treatment where and when needed. Towards this goal, ambulatory assessment encompasses methodological approaches to investigate behavioral, physiological, and biological processes in humans' everyday life. It combines repeated assessments of symptomatology over time, e.g., via Ecological Momentary Assessment (e.g., smartphone-diaries), with monitoring of physical behavior, environmental characteristics (such as geolocations, social interactions) and physiological function via sensors, e.g., mobile accelerometers, global-positioning-systems, and electrocardiography. In this review, we expand on promises of ambulatory assessment in the investigation of mental states (e.g., real-life, dynamical and contextual perspective), on chances for precision psychiatry such as the prediction of courses of psychiatric disorders, detection of tipping points and critical windows of relapse, and treatment effects as exemplified by ongoing projects, and on future avenues of how ambulatory interventions can benefit personalized care for psychiatric patients (e.g., through real-time feedback in everyday life). Ambulatory assessment is a key contributor to precision psychiatry, opening up promising avenues in research, diagnoses, prevention and treatment.
Collapse
Affiliation(s)
- Markus Reichert
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany; mental mHealth Lab, Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Baden-Wuerttemberg, Germany; Department of eHealth and Sports Analytics, Faculty of Sports Science, Ruhr-University Bochum (RUB), 44801 Bochum, North Rhine-Westphalia, Germany.
| | - Gabriela Gan
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Malika Renz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Urs Braun
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Sarah Brüßler
- mental mHealth Lab, Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Irina Timm
- mental mHealth Lab, Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Ren Ma
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Oksana Berhe
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Anastasia Benedyk
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Alexander Moldavski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Janina I Schweiger
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Oliver Hennig
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Francesca Zidda
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Christine Heim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Ulrich W Ebner-Priemer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany; mental mHealth Lab, Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, 68159 Mannheim, Baden-Wuerttemberg, Germany.
| |
Collapse
|
10
|
Ferrar J, Griffith GJ, Skirrow C, Cashdollar N, Taptiklis N, Dobson J, Cree F, Cormack FK, Barnett JH, Munafò MR. Developing Digital Tools for Remote Clinical Research: How to Evaluate the Validity and Practicality of Active Assessments in Field Settings. J Med Internet Res 2021; 23:e26004. [PMID: 34142972 PMCID: PMC8277353 DOI: 10.2196/26004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/23/2021] [Accepted: 05/04/2021] [Indexed: 01/27/2023] Open
Abstract
The ability of remote research tools to collect granular, high-frequency data on symptoms and digital biomarkers is an important strength because it circumvents many limitations of traditional clinical trials and improves the ability to capture clinically relevant data. This approach allows researchers to capture more robust baselines and derive novel phenotypes for improved precision in diagnosis and accuracy in outcomes. The process for developing these tools however is complex because data need to be collected at a frequency that is meaningful but not burdensome for the participant or patient. Furthermore, traditional techniques, which rely on fixed conditions to validate assessments, may be inappropriate for validating tools that are designed to capture data under flexible conditions. This paper discusses the process for determining whether a digital assessment is suitable for remote research and offers suggestions on how to validate these novel tools.
Collapse
Affiliation(s)
- Jennifer Ferrar
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Gareth J Griffith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Caroline Skirrow
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Cambridge Cognition Ltd, Cambridge, United Kingdom
| | - Nathan Cashdollar
- Cambridge Cognition Ltd, Cambridge, United Kingdom.,Cambridge Cognition Ltd, Cambridge, MA, United States
| | | | - James Dobson
- Cambridge Cognition Ltd, Cambridge, United Kingdom
| | - Fiona Cree
- Cambridge Cognition Ltd, Cambridge, United Kingdom
| | | | - Jennifer H Barnett
- Cambridge Cognition Ltd, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Marcus R Munafò
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
11
|
Affective structure, measurement invariance, and reliability across different experience sampling protocols. JOURNAL OF RESEARCH IN PERSONALITY 2021. [DOI: 10.1016/j.jrp.2021.104094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
12
|
Moukhtarian TR, Reinhard I, Moran P, Ryckaert C, Skirrow C, Ebner-Priemer U, Asherson P. Comparable emotional dynamics in women with ADHD and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2021; 8:6. [PMID: 33579385 PMCID: PMC7879647 DOI: 10.1186/s40479-021-00144-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) is a core diagnostic symptom in borderline personality disorder (BPD) and an associated feature of attention-deficit/hyperactivity disorder (ADHD). We aimed to investigate differences in dynamical indices of ED in daily life in ADHD and BPD. METHODS We used experience sampling method (ESM) and multilevel modelling to assess momentary changes in reports of affective symptoms, and retrospective questionnaire measures of ED in a sample of 98 adult females with ADHD, BPD, comorbid ADHD+BPD and healthy controls. RESULTS We found marked differences between the clinical groups and healthy controls. However, the ESM assessments did not show differences in the intensity of feeling angry and irritable, and the instability of feeling sad, irritable and angry, findings paralleled by data from retrospective questionnaires. The heightened intensity in negative emotions in the clinical groups compared to controls was only partially explained by bad events at the time of reporting negative emotions, suggesting both reactive and endogenous influences on ED in both ADHD and BPD. CONCLUSIONS This study supports the view that ED is a valuable trans-diagnostic aspect of psychopathology in both ADHD and BPD, with similar levels of intensity and instability. These findings suggest that the presence or severity of ED should not be used in clinical practice to distinguish between the two disorders.
Collapse
Affiliation(s)
- Talar R Moukhtarian
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Iris Reinhard
- Central Institute of Mental Health, Division of Biostatistics, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Paul Moran
- Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Celine Ryckaert
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Caroline Skirrow
- Cambridge Cognition, Cambridge, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Ulrich Ebner-Priemer
- Mental m-health lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany. .,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
| | - Philip Asherson
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|
13
|
Burgess-Hull A, Epstein DH. Ambulatory Assessment Methods to Examine Momentary State-Based Predictors of Opioid Use Behaviors. CURRENT ADDICTION REPORTS 2021; 8:122-135. [PMID: 33425652 PMCID: PMC7778403 DOI: 10.1007/s40429-020-00351-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Addiction scientists have begun using ambulatory assessment methods-including ecological momentary assessment (EMA), experience sampling, and daily diaries-to collect real-time or near-real-time reports of participants' internal states in their natural environments. The goal of this short review is to synthesize EMA findings from our research group, which has studied several hundred outpatients during treatment for opioid-use disorder (OUD). (We cite pertinent findings from other groups, but have not tried to be comprehensive.) One of our main goals in using EMA is to examine momentary changes in internal states that proximally predict, or concurrently mark, events such as lapses to opioid use. RECENT FINDINGS We summarize findings evaluating several classes of momentary markers or predictors (craving, stress, negative and positive moods, and physical pain/discomfort) of lapses and other states/behaviors. Craving and some negatively valenced mood states are concurrently and prospectively associated with lapses to opioid use during treatment. Craving is also concurrently and prospectively associated with momentary changes in stress and mood. Convincing evidence has not yet emerged for stress as a robust redictor of lapse to opioid use; it appears to be contributory, but neither necessary nor sufficient. SUMMARY Ambulatory assessment can capture changes in internal states and drug-related behaviors in situ and at high temporal resolution. We recommend research strategies that may increase the clinical and prognostic utility of ambulatory assessment, including denser sampling (i.e., more assessments per day) and more attention to heterogeneity across people and across populations.
Collapse
Affiliation(s)
- Albert Burgess-Hull
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD USA
| | - David H. Epstein
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD USA
| |
Collapse
|
14
|
Self-esteem instability and affective instability in everyday life after remission from borderline personality disorder. Borderline Personal Disord Emot Dysregul 2020; 7:25. [PMID: 33292714 PMCID: PMC7684893 DOI: 10.1186/s40479-020-00140-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is defined by a pervasive pattern of instability. According to prior findings and clinical theories, self-esteem instability and affective instability are key features of BPD. Previous e-diary studies showed that instability in self-esteem is heightened and that it is highly intertwined with affective instability in BPD in comparison to healthy controls (HC). The present study sought to extend these findings by adding symptomatologically remitted BPD patients (BPD-REM), i.e. former patients with BPD who met four or fewer BPD criteria within the past year, as a comparison group. METHODS To examine differences regarding self-esteem instability and affective instability, we used e-diaries for repeatedly collecting data on self-esteem, valence, and tense arousal 12 times a day for four consecutive days while participants underwent their daily life activities. Determining three different state-of-the-art instability indices and applying multilevel analyses, we compared 35 BPD-REM participants with previously reported 60 acute BPD patients (BPD-ACU) and 60 HC. RESULTS Our results revealed that self-esteem instability was significantly lower in the BPD-REM compared to the BPD-ACU group, irrespective of the instability index. In contrast, there were no significant differences regarding affective instability between the BPD-REM participants and those in the BPD-ACU group. The comparison between the BPD-REM with the HC indicated both a significantly higher instability in self-esteem as well as significantly heightened affective instability in the BPD-REM participants. Moreover, even though the associations were not significant, we found tentative support for the assumption that affective changes that are accompanied by changes in self-esteem are experienced as more burdensome and negatively impact the quality of life of remitted BPD participants. CONCLUSIONS This study builds on growing evidence for the importance of self-esteem instability in BPD. Whereas affective instability has been reported in various psychiatric disorders and might indeed constitute a transdiagnostic marker of affective dysregulation, our results indicate that self-esteem instability might be a specific symptom that construes the unique pathology in BPD.
Collapse
|
15
|
Eisele G, Vachon H, Lafit G, Kuppens P, Houben M, Myin-Germeys I, Viechtbauer W. The Effects of Sampling Frequency and Questionnaire Length on Perceived Burden, Compliance, and Careless Responding in Experience Sampling Data in a Student Population. Assessment 2020; 29:136-151. [DOI: 10.1177/1073191120957102] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently, little is known about the association between assessment intensity, burden, data quantity, and data quality in experience sampling method (ESM) studies. Researchers therefore have insufficient information to make informed decisions about the design of their ESM study. Our aim was to investigate the effects of different sampling frequencies and questionnaire lengths on burden, compliance, and careless responding. Students ( n = 163) received either a 30- or 60-item questionnaire three, six, or nine times per day for 14 days. Preregistered multilevel regression analyses and analyses of variance were used to analyze the effect of design condition on momentary outcomes, changes in those outcomes over time, and retrospective outcomes. Our findings offer support for increased burden and compromised data quantity and quality with longer questionnaires, but not with increased sampling frequency. We therefore advise against the use of long ESM questionnaires, while high-sampling frequencies do not seem to be associated with negative consequences.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Wolfgang Viechtbauer
- KU Leuven, Leuven, Belgium
- Maastricht University, Maastricht, Limburg, Netherlands
| |
Collapse
|
16
|
Sicorello M, Dieckmann L, Moser D, Lux V, Luhmann M, Neubauer AB, Schlotz W, Kumsta R. Highs and lows: Genetic susceptibility to daily events. PLoS One 2020; 15:e0237001. [PMID: 32790782 PMCID: PMC7425846 DOI: 10.1371/journal.pone.0237001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/17/2020] [Indexed: 01/01/2023] Open
Abstract
Why people differ in their susceptibility to external events is essential to our understanding of personality, human development, and mental disorders. Genes explain a substantial portion of these differences. Specifically, genes influencing the serotonin system are hypothesized to be differential susceptibility factors, determining a person’s reactivity to both positive and negative environments. We tested whether genetic variation in the serotonin transporter (5-HTTLPR) is a differential susceptibility factor for daily events. Participants (N = 326, 77% female, mean age = 25, range = 17–36) completed smartphone questionnaires four times a day over four to five days, measuring stressors, uplifts, positive and negative affect. Affect was predicted from environment valence in the previous hour on a within-person level using three-level autoregressive linear mixed models. The 5-HTTLPR fulfilled all criteria of a differential susceptibility factor: Positive affect in carriers of the short allele (S) was less reactive to both uplifts and stressors, compared to homozygous carriers of the long allele (L/L). This pattern might reflect relative affective inflexibility in S-allele carriers. Our study provides insight into the serotonin system’s general role in susceptibility and highlights the need to assess the whole spectrum of naturalistic experiences.
Collapse
Affiliation(s)
- Maurizio Sicorello
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Linda Dieckmann
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Germany
| | - Dirk Moser
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Germany
| | - Vanessa Lux
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Germany
| | - Maike Luhmann
- Department of Psychological Methods, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Andreas B. Neubauer
- DIPF | Leibniz Institute for Research and Information in Education, Frankfurt am Main, Frankfurt, Germany
| | - Wolff Schlotz
- Max-Planck-Institute for Empirical Aesthetics, Frankfurt am Main, Frankfurt, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Frankfurt, Germany
| | - Robert Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Germany
- * E-mail:
| |
Collapse
|
17
|
Wang D, Schneider S, Schwartz JE, Stone AA. Heightened Stress in Employed Individuals Is Linked to Altered Variability and Inertia in Emotions. Front Psychol 2020; 11:1152. [PMID: 32612555 PMCID: PMC7309515 DOI: 10.3389/fpsyg.2020.01152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
Stress has been widely recognized as a key factor contributing to health outcomes and psychological well-being. While some growing evidence points to stress as having an effect on emotion dynamics characteristics, there has yet to be a test of how global perceptions of stress are associated with not only average levels of emotions but also the variability in the intensity of the emotions, as well as how emotions linger (inertia), and whether these characteristics differ by age. In an effort to better understand how stress influences the emotional experiences of individuals, we examined associations between perceived stress levels and emotion dynamics indices in a sample of 859 working individuals over 24 h. Participants ranged in age from 21 to 81 years. Each participant was prompted at approximately 28 min intervals throughout a 24 h period to report intensity of emotional states. Overall, individuals who were more stressed experienced lower mean levels of positive emotions (with the exception of higher levels of excitement) and higher mean levels of negative emotions. They also experienced more pronounced variability in both positive and negative emotions, and greater inertia in negative emotions. We also found some evidence for age-related differences in mean levels and variability in certain emotions. The relationship of emotion dynamics indices to stress levels was not moderated by age. Many of the stress–emotion dynamics associations did not remain statistically significant upon controlling for the mean level of momentary emotions, indicating that the mean is a large component in the association.
Collapse
Affiliation(s)
- Diana Wang
- Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Stefan Schneider
- Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | | | - Arthur A Stone
- Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
18
|
Sicorello M, Dieckmann L, Moser D, Lux V, Luhmann M, Schlotz W, Kumsta R. Oxytocin and the stress buffering effect of social company: a genetic study in daily life. Soc Cogn Affect Neurosci 2020; 15:293-301. [PMID: 32227088 PMCID: PMC7235964 DOI: 10.1093/scan/nsaa034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
Social relationships are a crucial determinant of both mental and physical health. This effect is partly due to social buffering of stress. Animal studies suggest that social buffering is mediated via the oxytocin system, while studies in humans are sparse and limited by the low ecological validity of laboratory settings. In the present study, participants (N = 326) completed smartphone questionnaires four times a day over 4 to 5 days, measuring stressors, negative affect, and social context to assess social buffering. We found that under stress, participants reported a higher need for social company. Further, the impact of prior stressful events on momentary negative affect was attenuated by the perceived pleasantness of current social company. This social buffering effect was moderated by haplotypes of the oxytocin receptor gene, based on two well-described single nucleotide polymorphisms (rs2268498, rs53576). Effects were robust when controlling for gender and age, applying different data quality criteria, and even apparent in genotype-based analyses. Our findings demonstrate that social buffering and its modulation by oxytocin system characteristics have implications for life as lived outside the laboratory.
Collapse
Affiliation(s)
- Maurizio Sicorello
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Linda Dieckmann
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Dirk Moser
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Vanessa Lux
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Maike Luhmann
- Department of Psychological Methods, Faculty of Psychology, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Wolff Schlotz
- Max-Planck-Institute for Empirical Aesthetics, Frankfurt am Main, Frankfurt am Main, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Frankfurt am Main, Germany
| | - Robert Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, 44801 Bochum, Germany
| |
Collapse
|
19
|
Reply to: Context matters for affective chronometry. Nat Hum Behav 2020; 4:690-693. [PMID: 32341492 DOI: 10.1038/s41562-020-0861-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/13/2020] [Indexed: 11/08/2022]
|
20
|
Sperry SH, Walsh MA, Kwapil TR. Emotion dynamics concurrently and prospectively predict mood psychopathology. J Affect Disord 2020; 261:67-75. [PMID: 31600589 DOI: 10.1016/j.jad.2019.09.076] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/04/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Altered emotion dynamics may represent a transdiagnostic risk factor for mood psychopathology. The present study examined whether altered emotion dynamics were associated with bipolar and depressive psychopathology concurrently and at a three-year follow-up. METHODS At baseline (n = 138), participants completed diagnostic interviews, questionnaires, and seven days of experience sampling assessments. Four emotion dynamics were computed for negative affect (NA) and positive affect (PA) - within-person variance (variability), mean square of successive differences and probability of acute change (instability), and autocorrelation (inertia). At the three-year follow-up, participants (n = 108) were re-assessed via interviews and questionnaires. RESULTS NA variability was associated with bipolar spectrum disorders at baseline and follow-up. NA instability predicted depressive symptoms and hypomanic personality at baseline, and bipolar spectrum disorders at the follow-up. NA inertia did not predict diagnoses or symptoms at either assessment. PA inertia predicted hyperthymic temperament at baseline but not follow-up. Notably, NA variability and instability predicted the development of new bipolar spectrum disorders at the follow-up. LIMITATIONS Consistent with the recruitment strategy and young age of the participants, only 50% had developed diagnosable psychopathology by the time of the follow-up assessment. CONCLUSIONS The present study provided a unique demonstration that altered emotion dynamics differentially predicted bipolar and depressive psychopathology concurrently and prospectively. Emotion dynamics are important to both digital phenotyping and mobile-based interventions as emotional instability offers a measurable risk factor that is identifiable prior to illness onset.
Collapse
Affiliation(s)
- Sarah H Sperry
- University of Illinois, Urbana-Champaign, IL, United States.
| | - Molly A Walsh
- University of North Carolina, Greensboro, NC, United States
| | - Thomas R Kwapil
- University of Illinois, Urbana-Champaign, IL, United States; University of North Carolina, Greensboro, NC, United States
| |
Collapse
|
21
|
Duvenage M, Uink BN, Zimmer-Gembeck MJ, Barber BL, Donovan CL, Modecki KL. Ambulatory Assessment of Adolescent Coping: It's a Complicated Process. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2019; 29:578-594. [PMID: 31573763 DOI: 10.1111/jora.12468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Scholars have long-called for researchers to treat coping as a process that is measured over an arc of time. Ambulatory assessment (AA) offers an appealing tool for capturing the dynamic process of adolescent coping. However, challenges in capturing the coping process are not altogether circumvented with AA designs. We conducted a scoping review of the AA literature on adolescent coping and draw from 60 studies to provide an overview of the field. We provide critiques of different AA approaches and highlight benefits and costs associated with various types of measurement within AA. We also speak to considerations of participant burden and compliance. We conclude with recommendations for developmental scholars seeking to deploy AA to capture this quintessential process among adolescents.
Collapse
|
22
|
Dejonckheere E, Mestdagh M, Houben M, Rutten I, Sels L, Kuppens P, Tuerlinckx F. Complex affect dynamics add limited information to the prediction of psychological well-being. Nat Hum Behav 2019; 3:478-491. [DOI: 10.1038/s41562-019-0555-0] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 02/06/2019] [Indexed: 01/07/2023]
|
23
|
Janssens KAM, Bos EH, Rosmalen JGM, Wichers MC, Riese H. A qualitative approach to guide choices for designing a diary study. BMC Med Res Methodol 2018; 18:140. [PMID: 30445926 PMCID: PMC6240196 DOI: 10.1186/s12874-018-0579-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Electronic diaries are increasingly used in diverse disciplines to collect momentary data on experienced feelings, cognitions, behavior and social context in real life situations. Choices to be made for an effective and feasible design are however a challenge. Careful and detailed documentation of argumentation of choosing a particular design, as well as general guidelines on how to design such studies are largely lacking in scientific papers. This qualitative study provides a systematic overview of arguments for choosing a specific diary study design (e.g. time frame) in order to optimize future design decisions. Methods During the first data assessment round, 47 researchers experienced in diary research from twelve different countries participated. They gave a description of and arguments for choosing their diary design (i.e., study duration, measurement frequency, random or fixed assessment, momentary or retrospective assessment, allowed delay to respond to the beep). During the second round, 38 participants (81%) rated the importance of the different themes identified during the first assessment round for the different diary design topics. Results The rationales for diary design choices reported during the first round were mostly strongly related to the research question. The rationales were categorized into four overarching themes: nature of the variables, reliability, feasibility, and statistics. During the second round, all overarching themes were considered important for all diary design topics. Conclusions We conclude that no golden standard for the optimal design of a diary study exists since the design depends heavily upon the research question of the study. The findings of the current study are helpful to explicate and guide the specific choices that have to be made when designing a diary study. Electronic supplementary material The online version of this article (10.1186/s12874-018-0579-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Karin A M Janssens
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. .,Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands.
| | - Elisabeth H Bos
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Developmental Psychology, University of Groningen, Groningen, the Netherlands
| | - Judith G M Rosmalen
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marieke C Wichers
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
24
|
Abstract
In recent years, significant technological advances have changed our understanding of dynamic processes in clinical psychology. A particularly important agent of change has been ambulatory assessment (AA). AA is the assessment of individuals in their daily lives, combining the twin benefits of increased ecological validity and minimized retrospective biases. These benefits make AA particularly well-suited to the assessment of dynamic processes, and recent advancements in technology are providing exciting new opportunities to understand these processes in new ways. In the current article, we briefly detail the capabilities currently offered by smartphones and mobile physiological devices, as well as some of the practical and ethical challenges of incorporating these new technologies into AA research. We then provide several examples of recent innovative applications of AA methodology in clinical research, assessment, and intervention and provide a case example of AA data generated from a study utilizing multiple mobile devices. In this way, we aim to provide a sense of direction for researchers planning AA studies of their own.
Collapse
|
25
|
Kockler TD, Santangelo PS, Ebner-Priemer UW. Investigating Binge Eating Using Ecological Momentary Assessment: The Importance of an Appropriate Sampling Frequency. Nutrients 2018; 10:nu10010105. [PMID: 29351219 PMCID: PMC5793333 DOI: 10.3390/nu10010105] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tobias D Kockler
- Mental mHealth Lab, Karlsruhe Institute of Technology, 76187 Karlsruhe, Germany.
| | - Philip S Santangelo
- Mental mHealth Lab, Karlsruhe Institute of Technology, 76187 Karlsruhe, Germany.
| | | |
Collapse
|
26
|
Moukhtarian TR, Mintah RS, Moran P, Asherson P. Emotion dysregulation in attention-deficit/hyperactivity disorder and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2018; 5:9. [PMID: 29796281 PMCID: PMC5960499 DOI: 10.1186/s40479-018-0086-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/12/2018] [Indexed: 01/28/2023] Open
Abstract
There is ongoing debate on the overlap between Attention-Deficit/Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD), particularly regarding emotion dysregulation (ED). In this paper, we present a narrative review of the available evidence on the association of these two disorders from several standpoints. First, we discuss the unique and shared diagnostic criteria for ADHD and BPD, focusing particularly on ED. We consider the methodology of ecological momentary assessment and discuss why this approach could be an alternative and more accurate way to qualitatively distinguish between ADHD and BPD. We summarise key findings on the genetic and environmental risk factors for ADHD and BPD and the extent to which there are shared or unique aetiological and neurobiological risk factors. Finally, we discuss the clinical relevance of considering both disorders in the assessment of patients presenting with trait-like behavioural syndromes, distinguishing the two conditions and implications for treatment.
Collapse
Affiliation(s)
- Talar R Moukhtarian
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Ruth S Mintah
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Paul Moran
- 2Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN UK
| | - Philip Asherson
- 1King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| |
Collapse
|
27
|
de Haan-Rietdijk S, Voelkle MC, Keijsers L, Hamaker EL. Discrete- vs. Continuous-Time Modeling of Unequally Spaced Experience Sampling Method Data. Front Psychol 2017; 8:1849. [PMID: 29104554 PMCID: PMC5655034 DOI: 10.3389/fpsyg.2017.01849] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022] Open
Abstract
The Experience Sampling Method is a common approach in psychological research for collecting intensive longitudinal data with high ecological validity. One characteristic of ESM data is that it is often unequally spaced, because the measurement intervals within a day are deliberately varied, and measurement continues over several days. This poses a problem for discrete-time (DT) modeling approaches, which are based on the assumption that all measurements are equally spaced. Nevertheless, DT approaches such as (vector) autoregressive modeling are often used to analyze ESM data, for instance in the context of affective dynamics research. There are equivalent continuous-time (CT) models, but they are more difficult to implement. In this paper we take a pragmatic approach and evaluate the practical relevance of the violated model assumption in DT AR(1) and VAR(1) models, for the N = 1 case. We use simulated data under an ESM measurement design to investigate the bias in the parameters of interest under four different model implementations, ranging from the true CT model that accounts for all the exact measurement times, to the crudest possible DT model implementation, where even the nighttime is treated as a regular interval. An analysis of empirical affect data illustrates how the differences between DT and CT modeling can play out in practice. We find that the size and the direction of the bias in DT (V)AR models for unequally spaced ESM data depend quite strongly on the true parameter in addition to data characteristics. Our recommendation is to use CT modeling whenever possible, especially now that new software implementations have become available.
Collapse
Affiliation(s)
- Silvia de Haan-Rietdijk
- Methodology and Statistics for the Behavioural, Biomedical and Social Sciences, Utrecht University, Utrecht, Netherlands
| | - Manuel C Voelkle
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.,Psychological Methods, Humboldt University Berlin, Berlin, Germany
| | - Loes Keijsers
- Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Ellen L Hamaker
- Methodology and Statistics for the Behavioural, Biomedical and Social Sciences, Utrecht University, Utrecht, Netherlands.,Quantitative Psychology and Individual Differences, Catholic University Leuven, Leuven, Belgium
| |
Collapse
|
28
|
Timm C, Ubl B, Zamoscik V, Ebner-Priemer U, Reinhard I, Huffziger S, Kirsch P, Kuehner C. Cognitive and affective trait and state factors influencing the long-term symptom course in remitted depressed patients. PLoS One 2017; 12:e0178759. [PMID: 28575049 PMCID: PMC5456349 DOI: 10.1371/journal.pone.0178759] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 05/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background Major depressive disorder (MDD) is characterized by a high risk for relapses and chronic developments. Clinical characteristics such as residual symptoms have been shown to negatively affect the long-term course of MDD. However, it is unclear so far how trait repetitive negative thinking (RNT) as well as cognitive and affective momentary states, the latter experienced during daily-life, affect the long-term course of MDD. Method We followed up 57 remitted depressed (rMDD) individuals six (T2) and 36 (T3) months after baseline. Clinical outcomes were time to relapse, time spent with significant symptoms as a marker of chronicity, and levels of depressive symptoms at T2 and T3. Predictors assessed at baseline included residual symptoms and trait RNT. Furthermore, momentary daily life affect and momentary rumination, and their variation over the day were assessed at baseline using ambulatory assessment (AA). Results In multiple models, residual symptoms and instability of daily-life affect at baseline independently predicted a faster time to relapse, while chronicity was significantly predicted by trait RNT. Multilevel models revealed that depressive symptom levels during follow-up were predicted by baseline residual symptom levels and by instability of daily-life rumination. Both instability features were linked to a higher number of anamnestic MDD episodes. Conclusions Our findings indicate that trait RNT, but also affective and cognitive processes during daily life impact the longer-term course of MDD. Future longitudinal research on the role of respective AA-phenotypes as potential transdiagnostic course-modifiers is warranted.
Collapse
Affiliation(s)
- Christina Timm
- Research Group Longitudinal and Intervention Research, Department of Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bettina Ubl
- Research Group Longitudinal and Intervention Research, Department of Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Vera Zamoscik
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrich Ebner-Priemer
- Karlsruhe Institute of Technology, Institut für Sport und Sportwissenschaften, University of Karlsruhe, Karlsruhe, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Silke Huffziger
- Research Group Longitudinal and Intervention Research, Department of Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christine Kuehner
- Research Group Longitudinal and Intervention Research, Department of Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
29
|
Kockler TD, Tschacher W, Santangelo PS, Limberger MF, Ebner-Priemer UW. Specificity of emotion sequences in borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls: an e-diary study. Borderline Personal Disord Emot Dysregul 2017; 4:26. [PMID: 29276606 PMCID: PMC5738798 DOI: 10.1186/s40479-017-0077-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) exhibit dysregulated emotion sequences in daily life compared to healthy controls (HC). Empirical evidence regarding the specificity of these findings is currently lacking. METHODS To replicate dysregulated emotion sequences in patients with BPD and to investigate the specificity of the sequences, we used e-diaries of 43 female patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 HC. To capture the rapid dynamics of emotions, we prompted participants every 15 min over a 24-h period to assess their current perceived emotions. We analyzed group differences in terms of activation, persistence, switches, and down-regulation of emotion sequences. RESULTS By comparing patients with BPD to HC, we replicated five of the seven previously reported dysregulated emotion sequences, as well as 111 out of 113 unaltered sequences. However, none of the previously reported dysregulated emotion sequences exhibited specificity, i.e., none revealed higher frequencies compared to the PTSD group or the BN group. Beyond these findings, we revealed a specific finding for patients with BN, as they most frequently switched from anger to disgust. CONCLUSIONS Replicating previously found dysregulated and unaltered emotional sequences strengthens the significance of emotion sequences. However, the lack of specificity points to emotion sequences as transdiagnostic features.
Collapse
Affiliation(s)
- Tobias D Kockler
- Karlsruhe Institute of Technology, Mental mHealth Lab, Karlsruhe, Germany
| | - Wolfgang Tschacher
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | | | | | | |
Collapse
|
30
|
Kleindienst N, Priebe K, Petri M, Hecht A, Santangelo P, Bohus M, Schulte-Herbrüggen O. Trauma-related memories in PTSD after interpersonal violence: an ambulatory assessment study. Eur J Psychotraumatol 2017; 8:1409062. [PMID: 29250304 PMCID: PMC5727453 DOI: 10.1080/20008198.2017.1409062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Ambulatory assessment (AA) is increasingly recommended for assessing symptoms of posttraumatic stress disorder (PTSD). Previous AA studies provided new insights into the phenomenology of trauma-related memories, but also divergent findings. Notably, the range of trauma-related memories (a major target of psychotherapeutic interventions) reported in AA studies was as wide as 7.3 to 74.5 per week which might result from different methods used in these studies. Objective: We aimed at assessing the frequency of trauma-related memories in PTSD related to interpersonal violence and investigated whether this frequency is dependent upon the method. Method: For each patient trauma-related memories were assessed using two variants of smartphone-based AA: (1) Event-based sampling (EBS), i.e. participants entered data on each intrusive memory as it occurred; (2) Time-based sampling (TBS), i.e. participants reported the number of trauma-related memories they had experienced during the last two hours after they had been alerted by the smartphone. The numbers reported during the TBS-block were either analysed as reported by the participants or restricted to one per hour (rTBS). The impact of smartphone-assessments on trauma-related memories was assessed during a post-monitoring questionnaire. Results: While trauma-related memories were frequent across assessments, the methodology had a huge impact on the numbers: EBS (median = 7) and rTBS (median = 6) yielded significantly lower weekly numbers of intrusive trauma-related memories than TBS (median = 49). Accordingly, the possibility to report unrestricted numbers of trauma-related memories clearly impacted the results. The post-monitoring questionnaire identified another source for the divergent findings: while feeling disrupted by the smartphone-assessments was unrelated to the numbers reported during EBS, feeling disrupted was related to an increase of trauma-related memories during TBS and rTBS. Conclusions: The method clearly impacts the recorded number of trauma-related memories. Future research should clarify whether other variables (e.g. the subjective stress related to intrusive memories) are less dependent on the methodology.
Collapse
Affiliation(s)
- Nikolaus Kleindienst
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Kathlen Priebe
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.,Department of Psychology, Faculty of Life Sciences, Humboldt-Universitaet zu Berlin, Berlin, Germany
| | - Mirja Petri
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Berlin, Germany
| | - Amélie Hecht
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Philip Santangelo
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.,Department of Sport and Sport Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.,Department of Health, University of Antwerp, Antwerp, Belgium
| | | |
Collapse
|
31
|
Santangelo PS, Koenig J, Funke V, Parzer P, Resch F, Ebner-Priemer UW, Kaess M. Ecological Momentary Assessment of Affective and Interpersonal Instability in Adolescent Non-Suicidal Self-Injury. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:1429-1438. [DOI: 10.1007/s10802-016-0249-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
32
|
Köhling J, Moessner M, Ehrenthal JC, Bauer S, Cierpka M, Kämmerer A, Schauenburg H, Dinger U. Affective Instability and Reactivity in Depressed Patients With and Without Borderline Pathology. J Pers Disord 2016; 30:776-795. [PMID: 26623534 DOI: 10.1521/pedi_2015_29_230] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The quality of depression in borderline personality disorder (BPD) was reported to differ from that in patients with major depressive disorder (MDD) only. However, little is known about affect dynamics in "borderline-depression." The authors assessed affective instability and reactivity in 20 MDD patients with BPD and in 21 MDD patients without BPD by Ambulatory Assessment. Participants reported on current affect, daily events, and attribution of affective states to events five times per day over a 7-day period. The results do not indicate higher affective instability in MDD patients with BPD comorbidity. Depressed patients with BPD reported less subjectively perceived affective reactivity, while observed associations between events and affect were not different between groups, except for one finding: In depressed patients with BPD, overall mood was lower after being alone. These findings suggest impaired attribution of mood changes and less tolerance of being alone as specific for depression in BPD.
Collapse
|
33
|
Spindler G, Stopsack M, Aldinger M, Grabe HJ, Barnow S. What about the “ups and downs” in our daily life? The influence of affective instability on mental health. MOTIVATION AND EMOTION 2015. [DOI: 10.1007/s11031-015-9509-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
34
|
Abstract
We discuss three varieties of affective dynamics (affective instability, emotional inertia, and emotional differentiation). In each case, we suggest how these affective dynamics should be operationalized and measured in daily life using time-intensive methods, like ecological momentary assessment or ambulatory assessment, and recommend time-sensitive analyses that take into account not only the variability but also the temporal dependency of reports. Studies that explore how these affective dynamics are associated with psychological disorders and symptoms are reviewed, and we emphasize that these affective processes are within a nexus of other components of emotion regulation.
Collapse
Affiliation(s)
- Timothy J Trull
- Department of Psychological Sciences, University of Missouri, USA
| | - Sean P Lane
- Department of Psychological Sciences, University of Missouri, USA
| | - Peter Koval
- School of Psychology, Australian Catholic University, Australia Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Belgium
| | - Ulrich W Ebner-Priemer
- Department of Sport and Sport Science and House of Competence, Karlsruhe Institute of Technology, Germany
| |
Collapse
|
35
|
Do Metacognitions and Intolerance of Uncertainty Predict Worry in Everyday Life? An Ecological Momentary Assessment Study. Behav Ther 2015; 46:532-43. [PMID: 26163716 DOI: 10.1016/j.beth.2015.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 01/27/2023]
Abstract
Cognitive models of generalized anxiety disorder (GAD) suggest that excessive worry is due to positive and negative metacognitive beliefs and/or intolerance of uncertainty. Empirical support mainly derives from cross-sectional studies with limited conclusiveness, using self-report measures and thereby possibly causing recall biases. The aim of the present study therefore was to examine the power of these cognitive variables to predict levels of worry in everyday life using Ecological Momentary Assessment (EMA). Metacognitions and intolerance of uncertainty were assessed using well-established self-report questionnaires in 41 nonclinical participants who subsequently completed ratings on worry intensity and burden on a portable device for 1week at seven times a day once every 2hours. Results showed significant associations of negative metacognitive beliefs and intolerance of uncertainty, but not positive metacognitive beliefs, with worry in everyday life. In multilevel regression analyses, a substantial proportion of variance of everyday worry could be accounted for by negative metacognitions over and above trait worry and daily hassles. Intolerance of uncertainty likewise emerged as a valid predictor when tested in isolation, but did not explain additional variance once negative metacognitions were controlled. The findings support current cognitive models of excessive worry and highlight the role of negative metacognitions. By using EMA to assess levels of worry in everyday life, they extend earlier findings focusing exclusively on retrospective questionnaire measures.
Collapse
|
36
|
Thielsch C, Ehring T, Nestler S, Wolters J, Kopei I, Rist F, Gerlach AL, Andor T. Metacognitions, worry and sleep in everyday life: Studying bidirectional pathways using Ecological Momentary Assessment in GAD patients. J Anxiety Disord 2015; 33:53-61. [PMID: 26005837 DOI: 10.1016/j.janxdis.2015.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The metacognitive model of generalized anxiety disorder proposes that negative metacognitive beliefs are crucial in the maintenance of excessive worry. Furthermore, according to the cognitive model of insomnia, worry leads to problems falling or staying asleep and poor sleep quality. In order to test the assumed causal relationships, the present study examined the time-dependent course of negative metacognition and worry as well as worry and sleep quality, using Ecological Momentary Assessment (EMA). METHOD Negative metacognitions, worry and sleep were assessed by self-report questionnaires as well as EMA in 56 GAD patients who carried a portable device for 1 week and logged sleep quality, negative metacognition and worry processes four times a day. RESULTS Metacognitions, worry and sleep were significantly correlated. Structural equation modeling using multilevel analyses showed a unidirectional relationship of negative metacognitions leading to prolonged worry processes and a bidirectional relationship of worry and sleep quality. CONCLUSIONS These findings support the theoretically derived assumptions on the relationship between negative metacognitions, worry and sleep. Implications for further research as well as clinical implications are discussed.
Collapse
Affiliation(s)
| | - Thomas Ehring
- Institute of Psychology, University of Münster, Germany; Department of Psychology, University of Munich, Germany
| | | | | | - Ina Kopei
- Institute of Psychology, University of Münster, Germany
| | - Fred Rist
- Institute of Psychology, University of Münster, Germany
| | | | - Tanja Andor
- Institute of Psychology, University of Münster, Germany
| |
Collapse
|
37
|
Quality and severity of depression in borderline personality disorder: A systematic review and meta-analysis. Clin Psychol Rev 2015; 37:13-25. [DOI: 10.1016/j.cpr.2015.02.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/31/2015] [Accepted: 02/05/2015] [Indexed: 12/21/2022]
|
38
|
Ovarian hormones and borderline personality disorder features: Preliminary evidence for interactive effects of estradiol and progesterone. Biol Psychol 2015; 109:37-52. [PMID: 25837710 DOI: 10.1016/j.biopsycho.2015.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022]
Abstract
Cyclical fluctuations in the ovarian hormones 17β-estradiol (E2; estrogen) and progesterone (P4) predict emotions, cognitive processes, and behaviors relevant to Borderline Personality Disorder (BPD); however, there are individual differences in sensitivity to normal hormone shifts. This study examined associations of naturally occurring hormonal changes with concurrent BPD feature expression. Forty women sampled for a flat distribution of the PAI-BOR (n=10 where T<50, n=10 where 50<T<60, n=10 where 60<T<70, and n=10 where T>70) provided four weekly saliva samples and psychological assessments. Across most outcomes (e.g., BPD features, felt rejection, anger rumination, negative urgency) P4 deviation (from one's person mean) moderated the effect of current E2 deviation (from one's person mean) among women high (+1 SD) in trait BPD features such that E2 deviation was negatively associated with symptoms only when P4 was higher-than-usual. Cyclical hormone changes (e.g., higher P4 in the luteal phase; E2 fluctuations at ovulation and in the luteal phase) may impact BPD feature expression among at-risk women.
Collapse
|
39
|
Santangelo P, Bohus M, Ebner-Priemer UW. Ecological momentary assessment in borderline personality disorder: a review of recent findings and methodological challenges. J Pers Disord 2014; 28:555-76. [PMID: 22984853 DOI: 10.1521/pedi_2012_26_067] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The use of Ecological Momentary Assessment (EMA) has led to increased insight into borderline personality disorder (BPD) symptoms, especially regarding affective instability. EMA is characterized by a series of repeated assessments of current affective, behavioral, and contextual experiences or physiological processes while participants engage in normal daily activities. EMA has several advantages. It enables researchers to avoid biased recollection, to investigate within-person processes, and to enhance real-life generalizability. This review is dedicated to four main objectives: (1) to discuss the characteristics of EMA in studying BPD symptomatology; (2) to provide an extensive overview of EMA findings in BPD structured into findings regarding DSM-IV criteria and findings regarding emotional dysregulation as stated in the biosocial theory of Linehan; (3) to discuss challenges of EMA and to give recommendations for the proper use of it; and (4) to highlight prospects and promising applications that should be addressed.
Collapse
|
40
|
Cavazzi T, Becerra R. Psychophysiological Research of Borderline Personality Disorder: Review and Implications for Biosocial Theory. EUROPES JOURNAL OF PSYCHOLOGY 2014. [DOI: 10.5964/ejop.v10i1.677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
41
|
Abstract
In the present article, we introduce the continuous unified electronic (CUE) diary method, a longitudinal, event-based, electronic parent report method that allows real-time recording of infant and child behavior in natural contexts. Thirty-nine expectant mothers were trained to identify and record target behaviors into programmed handheld computers. From birth to 18 months, maternal reporters recorded the initial, second, and third occurrences of seven target motor behaviors: palmar grasp, rolls from side to back, reaching when sitting, pincer grip, crawling, walking, and climbing stairs. Compliance was assessed as two valid entries per behavior: 97 % of maternal reporters met compliance criteria. Reliability was assessed by comparing diary entries with researcher assessments for three of the motor behaviors: palmar grasp, pincer grip and walking. A total of 81 % of maternal reporters met reliability criteria. For those three target behaviors, age of emergence was compared across data from the CUE diary method and researcher assessments. The CUE diary method was found to detect behaviors earlier and with greater sensitivity to individual differences. The CUE diary method is shown to be a reliable methodological tool for studying processes of change in human development.
Collapse
|
42
|
Abstract
Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients' everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues.
Collapse
Affiliation(s)
- Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri 65211-1350, USA.
| | | |
Collapse
|
43
|
Eidelman P, Gershon A, Kaplan K, McGlinchey E, Harvey AG. Social support and social strain in inter-episode bipolar disorder. Bipolar Disord 2012; 14:628-40. [PMID: 22862999 PMCID: PMC4321960 DOI: 10.1111/j.1399-5618.2012.01049.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study focused on social support and social strain and their cross-sectional associations with instabilities in sleep and social rhythms in inter-episode bipolar disorder (BD). METHODS Thirty-five adults diagnosed with inter-episode BD type I and 38 healthy controls completed measures of perceived social support and social strain. Group differences in support and strain were examined. Within the BD group, instabilities in sleep and social rhythms were assessed with 28 days of daily diary and actigraphy. Correlation and regression analyses were used to examine cross-sectional and prospective associations between social support, social strain, instabilities in sleep and social rhythms, and mood symptoms. RESULTS The BD group reported lower social support and higher social strain than the control group. Additionally, social strain was positively correlated with manic and depressive symptoms in the BD group. Furthermore, there was a cross-sectional association between social support and more stable sleep on actigraphy in the BD group, although social support did not predict future sleep instability. CONCLUSIONS These results indicate that inter-episode BD is associated with deficient social support and elevated social strain compared to controls, and that this may be due to persistent inter-episode mood symptoms. Social strain may be particularly important given its association with manic and depressive symptoms. The results also raise the possibility that sleep instability is related to poor social support in BD.
Collapse
Affiliation(s)
- Polina Eidelman
- San Francisco Bay Area Center for Cognitive Therapy, Oakland
| | - Anda Gershon
- Department of Psychiatry, Stanford University, Stanford
| | - Katherine Kaplan
- Department of Psychology, University of California at Berkeley, Berkeley, CA, USA
| | - Eleanor McGlinchey
- Department of Psychology, University of California at Berkeley, Berkeley, CA, USA
| | - Allison G Harvey
- Department of Psychology, University of California at Berkeley, Berkeley, CA, USA
| |
Collapse
|
44
|
Shiyko MP, Ram N. Conceptualizing and Estimating Process Speed in Studies Employing Ecological Momentary Assessment Designs: A Multilevel Variance Decomposition Approach. MULTIVARIATE BEHAVIORAL RESEARCH 2011; 46:875-899. [PMID: 22707796 PMCID: PMC3374659 DOI: 10.1080/00273171.2011.625310] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Researchers have been making use of ecological momentary assessment (EMA) and other study designs that sample feelings and behaviors in real time and in naturalistic settings to study temporal dynamics and contextual factors of a wide variety of psychological, physiological, and behavioral processes. As EMA designs become more widespread, questions are arising about the frequency of data sampling, with direct implications for participants' burden and researchers' ability to capture and study dynamic processes. Traditionally, spectral analytic techniques are used for time series data to identify process speed. However, the nature of EMA data, often collected with fewer than 100 measurements per person, sampled at randomly spaced intervals, and replete with planned and unplanned missingness, precludes application of traditional spectral analytic techniques. Building on principles of variance partitioning used in the generalizability theory of measurement and spectral analysis, we illustrate the utility of multilevel variance decompositions for isolating process speed in EMA-type data. Simulation and empirical data from a smoking-cessation study are used to demonstrate the method and to evaluate the process speed of smoking urges and quitting self-efficacy. Results of the multilevel variance decomposition approach can inform process-oriented theory and future EMA study designs.
Collapse
|
45
|
Instability of physical anxiety symptoms in daily life of patients with panic disorder and patients with posttraumatic stress disorder. J Anxiety Disord 2010; 24:792-8. [PMID: 20580527 DOI: 10.1016/j.janxdis.2010.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 03/02/2010] [Accepted: 06/02/2010] [Indexed: 11/22/2022]
Abstract
The present study examined severity as well as degree and temporal pattern of instability of DSM-IV-based bodily symptoms of anxiety (BSA) in daily life of 26 panic disorder (PD) patients, 17 posttraumatic stress disorder (PTSD) patients, and 28 healthy controls (HC) during 1 week, using electronic diaries. The ecological momentary assessment around every 3h during wake times was accepted well by patients. Compared to HC, patient groups exhibited elevated instability of BSA. BSA instability was more pronounced in PTSD than PD (p<0.005), even after controlling for mean symptom level. Numbers of symptomatic episodes were comparable in PTSD and PD, but the duration of symptom-free episodes was shorter in PTSD than PD. Results indicate that PTSD patients are particularly burdened by fluctuations in somatic symptoms of anxiety, implying perceived unpredictability and uncontrollability. Electronic diaries can be applied in innovative ways to provide novel insights into the phenomenology of anxiety disorders that may not be captured well by retrospective interviews and questionnaires.
Collapse
|
46
|
Wilhelm FH, Grossman P. Emotions beyond the laboratory: theoretical fundaments, study design, and analytic strategies for advanced ambulatory assessment. Biol Psychol 2010; 84:552-69. [PMID: 20132861 DOI: 10.1016/j.biopsycho.2010.01.017] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 01/19/2010] [Accepted: 01/26/2010] [Indexed: 12/30/2022]
Abstract
Questionnaire and interview assessment can provide reliable data on attitudes and self-perceptions on emotion, and experimental laboratory assessment can examine functional relations between stimuli and reactions under controlled conditions. On the other hand, ambulatory assessment is less constrained and provides naturalistic data on emotion in daily life, with the potential to (1) assure external validity of laboratory findings, (2) provide normative data on prevalence, quality and intensity of real-life emotion and associated processes, (3) characterize previously unidentified emotional phenomena, and (4) model real-life stimuli for representative laboratory research design. Technological innovations now allow for detailed ambulatory study of emotion across domains of subjective experience, overt behavior and physiology. However, methodological challenges abound that may compromise attempts to characterize biobehavioral aspects of emotion in the real world. For example, emotional effects can be masked by social engagement, mental and physical workloads, as well as by food intake and circadian and quasi-random variation in metabolic activity. The complexity of data streams and multitude of factors that influence them require a high degree of context specification for meaningful data interpretation. We consider possible solutions to typical and often overlooked issues related to ambulatory emotion research, including aspects of study design decisions, recording devices and channels, electronic diary implementation, and data analysis.
Collapse
Affiliation(s)
- Frank H Wilhelm
- University of Basel, Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Missionsstrasse 60/62, CH-4055 Basel, Switzerland.
| | | |
Collapse
|
47
|
Ebner-Priemer UW, Kubiak T. The Decade of Behavior Revisited. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2010. [DOI: 10.1027/1015-5759/a000021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ulrich W. Ebner-Priemer
- Karlsruhe Institute of Technology, Germany & Central Institute of Mental Health, Mannheim, Germany
| | - Thomas Kubiak
- Institute of Psychology, University of Greifswald, Germany
| |
Collapse
|
48
|
Myin-Germeys I, Oorschot M, Collip D, Lataster J, Delespaul P, van Os J. Experience sampling research in psychopathology: opening the black box of daily life. Psychol Med 2009; 39:1533-1547. [PMID: 19215626 DOI: 10.1017/s0033291708004947] [Citation(s) in RCA: 482] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A growing body of research suggests that momentary assessment technologies that sample experiences in the context of daily life constitute a useful and productive approach in the study of behavioural phenotypes and a powerful addition to mainstream cross-sectional research paradigms. Momentary assessment strategies for psychopathology are described, together with a comprehensive review of research findings illustrating the added value of daily life research for the study of (1) phenomenology, (2) aetiology, (3) psychological models, (4) biological mechanisms, (5) treatment and (6) gene-environment interactions in psychopathology. Overall, this review shows that variability over time and dynamic patterns of reactivity to the environment are essential features of psychopathological experiences that need to be captured for a better understanding of their phenomenology and underlying mechanisms. The Experience Sampling Method (ESM) allows us to capture the film rather than a snapshot of daily life reality of patients, fuelling new research into the gene-environment-experience interplay underlying psychopathology and its treatment.
Collapse
Affiliation(s)
- I Myin-Germeys
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
49
|
Nica EI, Links PS. Affective instability in borderline personality disorder: experience sampling findings. Curr Psychiatry Rep 2009; 11:74-81. [PMID: 19187713 DOI: 10.1007/s11920-009-0012-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Affective instability, defined as repeated, rapid, and abrupt shifts in mood, is considered the core pathology in borderline personality disorder. The temporal pattern of affective instability can be best captured with the experience sampling method-longitudinal assessment of people's affective states as they occur in real time and in their natural environment. A review of the experience sampling studies published to date for borderline personality disorder suggests the following mood variability pattern: intense negative mood, more frequent and abrupt mood changes than healthy controls and patients with major depression, and partial triggering of affect by external events. The method also has great potential to investigate the links between affective instability and other psychological and behavioral correlates of the disorder, such as suicide, lack of self-esteem, and erratic behaviors. However, the method requires systematic study to determine best data collection designs and mathematical models of mood variability.
Collapse
Affiliation(s)
- Elena Irina Nica
- University of Toronto, St. Michael's Hospital, 30 Bond Street, Shuter Wing, Room 2010d, Toronto, Ontario M5B1W8, Canada.
| | | |
Collapse
|
50
|
Abstract
Convergent experimental data, autobiographical studies, and investigations on daily life have all demonstrated that gathering information retrospectively is a highly dubious methodology. Retrospection is subject to multiple systematic distortions (i.e., affective valence effect, mood congruent memory effect, duration neglect; peak end rule) as it is based on (often biased) storage and recollection of memories of the original experience or the behavior that are of interest. The method of choice to circumvent these biases is the use of electronic diaries to collect self-reported symptoms, behaviors, or physiological processes in real time. Different terms have been used for this kind of methodology: ambulatory assessment, ecological momentary assessment, experience sampling method, and real-time data capture. Even though the terms differ, they have in common the use of computer-assisted methodology to assess self-reported symptoms, behaviors, or physiological processes, while the participant undergoes normal daily activities. In this review we discuss the main features and advantages of ambulatory assessment regarding clinical psychology and psychiatry: (a) the use of realtime assessment to circumvent biased recollection, (b) assessment in real life to enhance generalizability, (c) repeated assessment to investigate within person processes, (d) multimodal assessment, including psychological, physiological and behavioral data, (e) the opportunity to assess and investigate context-specific relationships, and (f) the possibility of giving feedback in real time. Using prototypic examples from the literature of clinical psychology and psychiatry, we demonstrate that ambulatory assessment can answer specific research questions better than laboratory or questionnaire studies.
Collapse
|