Ambulatory monitoring of biobehavioral processes in health and disease

Professional Practice Guidelines for Personality Assessment

The current paper conveys guidelines for personality assessment developed by a work group formed by the Society for Personality Assessment (SPA), which are intended to serve as an aid for best practices specific to personality assessment for professionals, and a source of information for consumers and policy makers. The guidelines were developed after a careful and systematic review of the literature on personality assessment and examination of practice patterns, and were refined through multiple rounds of input from stakeholders including members of SPA and other professionals routinely conducting personality assessment. The guidelines address the scope of personality assessment and current practice trends, minimum education and training qualifications, ethical practices, diversity considerations, assessment procedures, and appropriate applications. By following these guidelines and other established professional standards, psychologists can help ensure that they practice ethically, competently, with appropriate attention to diversity, and to the highest standards of the profession. These guidelines can function as a resource for educators and supervisors of personality assessment. Additionally, the guidelines will serve as a benchmark for best practices in personality assessment and, as such, represent a first step in what is hoped to be an evolution of ever improving personality assessment standards of practice.

The Role of Self-Control and the Presence of Enactment Models on Sugar-Sweetened Beverage Consumption: A Pilot Study

The objective of the present research was to investigate associations of dispositional and momentary self-control and the presence of other individuals consuming SSBs with the consumption frequency of sugar-sweetened beverages (SSBs) in a multi-country pilot study. We conducted an Ambulatory Assessment in which 75 university students (52 females) from four study sites carried smartphones and received prompts six times a day in their everyday environments to capture information regarding momentary self-control and the presence of other individuals consuming SSBs. Multilevel models revealed a statistically significant negative association between dispositional self-control and SSB consumption. Moreover, having more self-control than usual was only beneficial in regard to lower SSB consumption frequency, when other individuals consuming SSBs were not present but not when they were present. The findings support the hypothesis that self-control is an important factor regarding SSB consumption. This early evidence highlights self-control as a candidate to design interventions to promote healthier drinking through improved self-control.

Music Listening and Stress in Daily Life-a Matter of Timing

Purpose

Despite increasing evidence suggesting that music listening in daily life has stress-reducing effects, studies mostly rely on subjective, retrospective data on music listening. Thus, the temporal dynamics underlying the stress-reducing effect of music listening remain unclear. Therefore, we aimed to examine the temporal dynamics of the associations between stress and music listening by assessing subjective and objective data on music in daily life.

Design

An exploratory Ambulatory Assessment study examining a total of 60 participants (37 women), aged 18 to 34 years (M = 22.4 years, SD = 3.5) was conducted.

Methods

For 1 week, participants answered questions on music listening and stress six times per day via an electronic diary device, which additionally objectively sampled the exact time point of music listening and its duration.

Results

Self-reports on mere music listening were associated with lower stress reports, whereas objectively assessed data was not. However, concerning duration of music listening, both subjective and objective data on music listening showed associations between a minimum of 20 min of music listening and lower stress reports. Concerning the latency, objective data on music listening revealed that the association between stress reports and music listening occurs in a time-delayed manner.

Conclusions

Although the study design does not allow for causal inferences, substantial associations among subjectively and objectively assessed data on music listening were found to differentially affect the experience of stress after music listening. In particular, when focusing on the temporal dynamics, objectively assessed data allowed for a more fine-grained analysis. In consequence, subjectively and objectively reported data on music listening should be assessed jointly when investigating effects of music listening on health. Experimental research with rigorous methodological control is required in order to corroborate our findings in a laboratory setting.

Psychosocial Aspects of Continuous Glucose Monitoring: Connecting to the Patients' Experience

Continuous glucose monitoring (CGM) systems provide people with diabetes with valuable real-time information on glucose trajectories and trends, thus offering opportunities for improving diabetes self-management. Ample evidence from clinical trials underscores CGM effectiveness for biomedical outcomes including HbA1C and hypoglycemia. However, interindividual variability in CGM uptake seems to be substantial: Neither do all individuals with diabetes adopt CGM readily in their diabetes self-management, nor do all of them benefit from CGM. In this article, we focus on CGM effects on quality of life and the potential role of psychosocial patient characteristics for determining the uptake and outcomes of CGM. After providing a brief overview on existing evidence on psychosocial factors in CGM use, gaps in existing research are identified and directions for future research are proposed that could answer key research questions and offer guidance for clinical diabetes care.

Ambulatory and diary methods can facilitate the measurement of patient-reported outcomes

PURPOSE

Ambulatory and diary methods of self-reported symptoms and well-being have received increasing interest in recent years. These methods are a valuable addition to traditional strategies for the assessment of patient-reported outcomes (PROs) in that they capture patients' recent symptom experiences repeatedly in their natural environments. In this article, we review ways that incorporating diary methods into PRO measurement can facilitate research on quality of life.

METHODS

Several diary methods are currently available, and they include "real-time" (Ecological Momentary Assessment) and "near-real-time" (end-of-day assessments, Day Reconstruction Method) formats. We identify the key benefits of these methods for PRO research.

RESULTS

(1) In validity testing, diary assessments can serve as a standard for evaluating the ecological validity and for identifying recall biases of PRO instruments with longer-term recall formats. (2) In research and clinical settings, diaries have the ability to closely capture variations and dynamic changes in quality of life that are difficult or not possible to obtain from traditional PRO assessments. (3) In test construction, repeated diary assessments can expand understanding of the measurement characteristics (e.g., reliability, dimensionality) of PROs in that parameters for differences between people can be compared with those for variation within people.

CONCLUSIONS

Diary assessment strategies can enrich the repertoire of PRO assessment tools and enhance the measurement of patients' quality of life.

Self-Control in Daily Life

In this daily diary study, we investigated the flexibility-enhancing effects of positive affect on the self-reported success of self-control strategies followed in daily life; 297 participants completed a 13-day daily diary that included measures of positive affect, desire, and habit strength as well as three self-control strategies (i.e., monitoring, distraction, and stimulus control). We found specific effects of positive affect on self-control strategies: Individuals with higher positive affect were most successful when following a strategy of distraction (e.g., thinking about something else), particularly when faced with strong tempting desires. These results reinforce the idea that positive affect is associated with both cognitive flexibility and distractibility, which may help people distract them from tempting desires.

Ambulatory assessment as a means of longitudinal phenotypes characterization in psychiatric disorders

Ambulatory Assessment (AA) comprises the use of in-field methods to assess individuals' behavior, physiology, and the experience as they unfold in naturalistic settings. We propose that AA is favorable for the investigation of gene-environment interactions and for the search for endophenotypes, being able to assess the experienced environment and to track basic regulatory processes, such as stress reactivity, affective instability, and reward experience, which are potential common factors that underlie psychiatric disorders. In this article, we (a) first describe briefly the rationale of AA and summarize the key advantages of the approach, (b) highlight within-subject regulatory processes, such as stress reactivity, affective instability, and reward experience, (c) describe studies that used AA to examine genetic influences in psychiatric disorders, and (d) briefly review longitudinal studies that have investigated phenotypes of psychiatric disorders. The reported studies yielded promising, although sometimes inconclusive evidence for genetic effects on endophenotypes of psychiatric disorders. Moreover, most studies were twin or family studies, especially in stress-sensitivity research; thus, it is unclear which specific single nucleotide polymorphisms contribute to the endophenotypes of psychiatric disorders. We do hope that within-subject regulatory processes will enable us to clarify the fundamental psychological dimensions that cut across traditional disorders and link them to their genetic underpinnings.

A conceptual framework for the neurobiological study of resilience

The well-replicated observation that many people maintain mental health despite exposure to severe psychological or physical adversity has ignited interest in the mechanisms that protect against stress-related mental illness. Focusing on resilience rather than pathophysiology in many ways represents a paradigm shift in clinical-psychological and psychiatric research that has great potential for the development of new prevention and treatment strategies. More recently, research into resilience also arrived in the neurobiological community, posing nontrivial questions about ecological validity and translatability. Drawing on concepts and findings from transdiagnostic psychiatry, emotion research, and behavioral and cognitive neuroscience, we propose a unified theoretical framework for the neuroscientific study of general resilience mechanisms. The framework is applicable to both animal and human research and supports the design and interpretation of translational studies. The theory emphasizes the causal role of stimulus appraisal (evaluation) processes in the generation of emotional responses, including responses to potential stressors. On this basis, it posits that a positive (non-negative) appraisal style is the key mechanism that protects against the detrimental effects of stress and mediates the effects of other known resilience factors. Appraisal style is shaped by three classes of cognitive processes--positive situation classification, reappraisal, and interference inhibition--that can be investigated at the neural level. Prospects for the future development of resilience research are discussed.

Ambulatory measurement of the ECG T-wave amplitude

Ambulatory recording of the preejection period (PEP) can be used to measure changes in cardiac sympathetic nervous system (SNS) activity under naturalistic conditions. Here, we test the ECG T-wave amplitude (TWA) as an alternative measure, using 24-h ambulatory monitoring of PEP and TWA in a sample of 564 healthy adults. The TWA showed a decrease in response to mental stress and a monotonic decrease from nighttime sleep to daytime sitting and more physically active behaviors. Within-participant changes in TWA were correlated with changes in the PEP across the standardized stressors (r = .42) and the unstandardized naturalistic conditions (mean r = .35). Partialling out changes in heart rate and vagal effects attenuated these correlations, but they remained significant. Ambulatory TWA cannot replace PEP, but simultaneous recording of TWA and PEP provides a more comprehensive picture of changes in cardiac SNS activity in real-life settings.

Smoking cessation, depression, and exercise: empirical evidence, clinical needs, and mechanisms

INTRODUCTION

Smoking is significantly more common among persons with major depressive disorders (MDDs). Furthermore, smokers with MDD report more difficulties when they quit smoking (greater withdrawal symptoms, higher probability of relapse). The aim of this narrative review is to describe research on exercise and depression and exercise and smoking cessation.

METHODS

We have critically reviewed various smoking cessation intervention programs for depressive smokers examining (a) the protective effect of exercise against relapse for smokers with MDD and (b) the benefits of exercise for treating withdrawal symptoms. We have also reviewed the current literature investigating the mechanisms between exercise-depression and exercise-smoking.

RESULTS

This review suggests that exercise may reduce depressive symptoms following cessation and provide a useful strategy for managing withdrawal symptoms in smokers with MDD. Various psychological, biological, and genetic hypotheses have been tested (e.g., distraction hypothesis, expectations hypothesis, cortisol hypothesis) and few have obtained significant results.

CONCLUSIONS

It might be beneficial for health professionals to recommend physical activity and promote supervised exercise sessions for smokers with MDD during smoking cessation. Future research needs to examine relationships between exercise, smoking, and depression with transdisciplinary and ecological momentary assessment.

Ambulatory assessment

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.

Bringing the laboratory and clinic to the community: mobile technologies for health promotion and disease prevention

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