Background: Paper I [literature review] Anger is reported to be an important factor in suicidality yet there is no review in this area of research. Paper II [research study] Anger and suicidality are found in exaggerated levels in the prisoner population and their association required investigation using a novel and ecologically valid methodology. Aims: Paper I [literature review] To review studies which have investigated the relationship between anger and suicidality. Paper II [research study] To examine the relationship between anger and suicicidality in a sample of male prisoners. Paper III [critical review and appraisal] To critically review and appraise Papers I and II as well as the research processes involved. Methods: Paper I systematically reviewed 48 studies of anger and suicidality over a 20-year period. Paper II conducted an ecological momentary assessment study using multi-level modelling analysis to investigate anger and suicidality in a sample of adult male prisoners. Results: Paper I found preliminary evidence for a relationship between anger and suicidality which identified that the area required more empirically rigorous investigation, particularly using novel, ecologically valid methodology. In a sample of adult male prisoners, Paper II demonstrated that anger was temporally associated with suicidal ideation and related concepts. Anger was concurrently associated with suicidal ideation, when controlling for depression and hopelessness. Conclusions: Paper I indicated the potential relationship between anger and suicidality in clinical and non-clinical populations. Paper II revealed strong evidence of an association between concurrent anger and suicidality in adult male prisoners using ecologically valid assessment methods. Paper III examined the relevance of Papers I and II, in their independent additions to the empirical literature as to the relation between anger and suicidality.

The current study examined 236 undergraduate students in a week long twice-per-day ecological momentary assessment exploring the influence of baseline reward sensitivity and interactions between circadian variables (i.e., total sleep time, sleep quality) and daily measures of reward. Though primary study findings did not support reward sensitivity related moderation of sleep-reward pathways, a number of notable findings emerged. We found evidence of specific domains of reward sensitivity (anticipatory reward and reward responsiveness) which are uniquely related to daily experiences of reward. In addition, bidirectional circadian-reward pathways were found between sleep quality and daily rewards which suggests pathways towards reward-related engagement. Evidence also supported interactions between sleep quality and total sleep time on experience of daily reward, further highlighting the complexity of sleep-reward pathways and their relevance to mood symptoms.

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Objective: The purpose of the following study was to test the feasibility of using an ecological momentary assessment strategy during participation in water exercise. This assessment strategy was used to collect ratings of pain intensity level, affective status and self-efficacy for engaging in regular exercise prior to, during and following participation in water exercise for women with chronic pain. Design: Participants (N=15) completed six measures assessing physical activity level and reactions to physical activity and exercise participation and participated in elicitation interviews focused on their experiences with chronic pain and physical activity and exercise. Participants reported daily pain intensity levels, affect and self-efficacy each morning by phone and used cellular phones to report momentary ratings immediately following participation in water exercise for 6 weeks. Results: Participant profiles were developed to display patterns of pain intensity, affect and self-efficacy over the course of 6 weeks. Profiles indicated a variety of levels of exercise consistency in participants. Pain intensity, affect and self-efficacy varied over the course of an exercise event and revealed varied patterns across participants. Overall, momentary self-efficacy (M¹= 7.98, SD=1.65; M²= 8.29, SD=1.62; M³=8.45, SD=1.45) and affect mean ratings (M¹= 2.05, SD=1.42; M²= 2.76, SD=1.22; M³=3.02, SD=1.06) increased over the course of the exercise events while pain levels decreased from pre-exercise levels (M¹= 2.67, SD=2.30; M²= 1.85, SD=1.86; M³=1.95, SD=2.05). Elicitation interviews indicated themes related to the importance of enjoyment of exercise, social factors, and impact on pain level and overall physical condition. Final interviews provided information about the reactions of participants to the assessment strategy and offered insight into the acceptance of this approach for future studies of exercise behaviors. Conclusion: Overall, this approach to ecological momentary assessment of variables associated with exercise was acceptable to participants and revealed variable patterns of pain intensity, self-efficacy and affective state in relation to water-exercise engagement. / Ph. D.

This doctoral dissertation examine the specific role of the self-concept and of its different dimensions on the evolution of anorexic symptoms over a period of 140 consecutive days. in two different samples comprising 26 anorexic outpatients and inpatients and in 23 girls without eating disorders (ED). By applying an idiographic approach, the main results show that the level, instability and dynamic of self-concept dimensions, and more precisely of body attractiveness, represent potent predictors of psychological, behavioral (e.g. full score of Eating Disorders Inventory-Adolescent, EDI-A-24) and somatic (e.g. Body Mass Index, BMI) anorexic symptoms over medium (i.e. over a few months), short (i.e. over a few weeks) and very short (i.e. over a few days) periods of time. Moreover, multivariate regression analyses further show that the pattern of association between anorexic symptoms and self concept dimensions remains the same in both samples (anorexic and without ED). Moreover, the results of cross-correlations analyses reveal that anorexic symptoms are as unstable as the dimensions of self-concept, with which they appear to be intertwined. More precisely, body attractiveness, most often a) precedes the drive for thinness, b) is associated to bulimia according to a"vicious circle" phenomenon, and c) fluctuates with according to body dissatisfaction. However body attractiveness was not found to relate to anorexic girls final status at the end of the follow-up period (e.g. deterioration, improvement, stabilization, etc). Finally, the results from a qualitative analysis suggest that social events experienced as positive contribute to the improvement of anorexia nervosa.This appears to be explained by the potential of these events to break through anorectic girls known ego-centered tendencies. Taken as a whole, the 'results highlight the necessity of considering overall of dimensions of self-esteem and the"profiles" of girls with and without ED in preventive and therapeutic interventions for ED.

This article reviews the Electronically Activated Recorder (EAR) as an ambulatory ecological momentary assessment tool for the real-world observation of daily behavior. Technically, the EAR is an audio recorder that intermittently records snippets of ambient sounds while participants go about their lives. Conceptually, it is a naturalistic observation method that yields an acoustic log of a person’s day as it unfolds. The power of the EAR lies in unobtrusively collecting authentic real-life observational data. In preserving a high degree of naturalism at the level of the raw recordings, it resembles ethnographic methods; through its sampling and coding, it enables larger empirical studies. This article provides an overview of the EAR method; reviews its validity, utility, and limitations; and discusses it in the context of current developments in ambulatory assessment, specifically the emerging field of mobile sensing.

Purging Disorder (PD) is characterized by purging after normal or small amounts of food among individuals who are not underweight. Several studies indicate that PD is associated with distress and impairment, underscoring the need for intervention. However, little is known about factors that trigger and maintain purging in PD. This study examined antecedents and consequences of purging using Ecological Momentary Assessment (EMA), a design that involved repeated assessments of current psychological states in participants' natural environments. Women with PD (N = 24) were recruited from the community to make multiple daily ratings of affect, shape/weight concerns, violation of dietary rules, and stomach discomfort using random-, interval-, and event-contingent recordings over a two-week period. Multilevel model analyses were used to examine between-day differences (purge versus non-purge day) and within-day changes in psychological variables relative to purging behavior. Results supported study hypotheses that negative affect and shape/weight concerns would be higher and positive affect would be lower on days when participants purged compared to days they did not purge. In addition, antecedent analyses supported within-day increases in negative affect, shape/weight concerns, and stomach discomfort prior to purging; however, only changes in positive affect and shape/weight concerns on purge days differed from naturally-occurring changes observed on non-purge days. For consequence analyses, negative affect, shape/weight concerns, and stomach discomfort decreased following purging on purge days, and trajectories of change were significantly different from non-purge days. Finally, exploratory analyses suggested that lower levels of impulsivity enhanced associations between antecedent affect and purging. These data are crucial to understand why women with PD purge after consuming normal or small amounts of food and may point to specific targets for the development of effective interventions.

Ecological momentary assessment provides a unique way of studying quality of life factors of colorectal cancer patients. It has yet to be used to study the behavioral expression of distress or depression by colorectal cancer patients. The current study utilized the Electronically Activated Recorder (EAR) technology to capture the daily activities and conversations of forty-eight adults with colorectal cancer. The study had two purposes: 1) to test the feasibility of the EAR with colorectal cancer patients; 2) to examine separate (self-report and behavioral) indicators of physical functioning, coping, and social support for their relationship to depression. Study participants wore the EAR, a portable digital recorder, for two consecutive days as the EAR recorded 30 seconds every 12.5 minutes. The EAR digital data were transcribed and analyzed for behavioral and linguistic indicators of physical functioning, coping, and social support. The acoustic data were analyzed using the standardized coding system Social Environment Coding of Sound Inventory (SECSI) and the Linguistic Inquiry and Word Count (LIWC2007) computer program. The results provided preliminary evidence that the EAR operated as a feasible and non-disruptive tool for gathering naturalistic data about colorectal patients’ lives. The EAR data revealed information about both the colorectal patients’ internal emotional world as well as their external world which was characterized by solitary acts of daily living. Study subjects were more likely to accept and receive tangible support from others than directly discuss their cancer with others. Analysis of language found that personal disclosure to others was associated with coping through emotional support while causation words (e.g., because, effect, hence) were significantly related with self-report cognitive scales. Furthermore, the study found that first-person singular pronouns were associated not only with depression, but with appraisal of social support. Lastly, a predictive model was tested to see whether self-reported tangible and emotional support and behavioral coding of emotional support each contributed uniquely to the prediction of depression. Only self-reported tangible support was found to significantly predict depression. / text

BACKGROUND: There is significant evidence supporting a link between excessive digital media use and adverse mental health outcomes. Since the average American teenager spends approximately 7 hours a day using digital media, this relationship has become of considerable interest in the field of public health. Studies have shown that anxiety and depression may both be associated with increased screen time as well as with Problematic Internet Use (PIU). PIU refers to a set of symptoms related to an individual’s inability to control their use of the Internet and appears to have characteristics of both substance use disorders and impulse control disorders. However, research on PIU has many limitations, including the lack of formal diagnostic criteria, unequal gender representation in study samples, and the relative dearth of studies conducted in adolescents, especially those with pre-existing mental health issues due to their status as a protected population. This study aims to address these limitations in existing literature through use of ecological momentary assessment (EMA), a research method that samples participants in their own environment repeatedly using one of various data collection methods (e.g. paper and pencil diary, text message surveys, app-based surveys). The specific aims of this study were: 1) to explore the feasibility and acceptability of a six-week daily EMA protocol in a clinical population of adolescents and young adults using a smartphone application, 2) to describe the relationship between PIU and depression/anxiety in a clinical sample of adolescents and young adults ages 12-23, and 3) to identify possible relationships on which to focus future studies of problematic digital media use and psychiatric symptomatology in this vulnerable population. METHODS: The study enrolled 25 adolescents and young adults ages 12-22 years who owned a smartphone and received mental health services at a community hospital in the greater Boston area. Participants were surveyed once a day for six weeks using a smartphone application, mindLAMP, to record self-report data. The daily survey included validated depression, anxiety, and PIU scales (the PHQ-8, GAD-7, and PIU-SF-6, respectively) as well as two sub-surveys inquiring about risky online behaviors and screen time use, and were collected via mindLAMP surveys. Participants also completed a short exit survey once their study period concluded. Feasibility was assessed by evaluating the sample-wide mean rate of response on daily surveys for the six-week protocol, rates of daily survey initiation and completion, and study completion rate. Acceptability was determined based on whether this data collection method provided more data than the current standard of care, which typically involves one meeting per week for psychotherapy. RESULTS: 96% of participants completed the study, and results demonstrated a 39.8% mean response rate, 43.2% mean survey initiation rate, and 38.5% mean survey completion rate. Type of phone use (overall rate p=0.029, initiation rate p=0.023, completion rate p=0.037), presence of an anxiety disorder (overall rate p=0.006, initiation rate p=0.038, completion rate p=0.004), and presence of co-morbid diagnoses (overall rate p=0.042, completion rate p=0.047) were significantly related to response rate, whereas age, gender, symptom severity, presence of an affective disorder, gender dysphoria, or ADHD were not. Regarding specific aim two, significant associations were detected between symptom scale scores and PIU and risky online behavior assessment (QUAL) scores such that: PIU-SF-6 and GAD-7 scores were positively correlated (p=0.032), PIU-SF-6 and PHQ-8 scores were positively correlated (p=0.050), GAD-7 and QUAL scores were positively correlated (p=0.004), and PHQ-8 and QUAL scores were positively correlated (p=0.0002). These results replicate findings in the literature of a significant relationship between anxiety and depression and both PIU and risky online behaviors. The lack of observed significant relationship between PIU and QUAL contradicts findings within the literature, and is possibly due to our small sample size. Significant associations were not detected between between categorical diagnoses of ADHD, Anxiety Disorders, Affective Disorders, or Gender Dysphoria and PIU-SF-6 scores. CONCLUSIONS: Results indicate that this EMA protocol is feasible and acceptable in this population, suggesting that this methodology may represent a new avenue to conduct research in adolescents and young adults with mental health concerns and, in the future, deliver treatment to these individuals. Limitations of this study include small sample size and participant bias in self-report data. Recommendations for future research include replication of this EMA protocol with a larger number of participants, incorporating methodologies that address the self-report bias. / 2022-06-07T00:00:00Z

Indiana University-Purdue University Indianapolis (IUPUI) / Social dysfunction is a hallmark of schizophrenia and leads to significant disability and distress. Decreased positive and increased negative affect predict poorer social functioning in those with schizophrenia. Social functioning and affect have traditionally been measured in the laboratory; yet, these methods are limited. Experience sampling methods (ESM) offer more immediate, ecologically valid assessments of these constructs. The purpose of this study was to examine social functioning and affect in schizophrenia using a novel form of ESM that passively collects audio data. The two primary hypotheses were: 1) clinical status (schizophrenia versus control) will predict social functioning, level of positive affect, and level of negative affect; and 2) the relationship between clinical status and affect will be moderated by context (social versus non-social). Additional exploratory aims tested the convergent validity between traditional, laboratory-based assessments of social functioning and this novel ESM. Data was collected from 38 people with schizophrenia and 36 control participants; Results partially supported the hypotheses. As expected, laboratory measures of social functioning revealed that those with schizophrenia performed worse than controls. ESM measures of social functioning found that the schizophrenia group interacted with others at the same rate as the control group but did not exhibit as much social engagement. ESM measures of affect revealed the schizophrenia group reported more negative affect than controls, but no differences in positive affect were found. Social context did not moderate the relationship between clinical status and affect. Lastly, correlations between laboratory measures and ESM measures of social functioning were significant for the schizophrenia group but not the control group. Results further our understanding of social functioning and affect in those with schizophrenia and yield important implications for future work.