Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects’ current behaviors and experiences in real time, in subjects’ natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects’ lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding ligh...

Ecological Momentary Assessment

In diary studies, people provide frequent reports on the events and experiences of their daily lives. These reports capture the particulars of experience in a way that is not possible using traditional designs. We review the types of research questions that diary methods are best equipped to answer, the main designs that can be used, current technology for obtaining diary reports, and appropriate data analysis strategies. Major recent developments include the use of electronic forms of data collection and multilevel models in data analysis. We identify several areas of research opportunities: 1. in technology, combining electronic diary reports with collateral measures such as ambulatory heart rate; 2. in measurement, switching from measures based on between-person differences to those based on within-person changes; and 3. in research questions, using diaries to (a) explain why people differ in variability rather than mean level, (b) study change processes during major events and transitions, and (c) study interpersonal processes using dyadic and group diary methods.

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Diary Methods: Capturing Life as it is Lived

This review focuses on the pathway leading from the marital relationship to physical health. Evidence from 64 articles published in the past decade, particularly marital interaction studies, suggests that marital functioning is consequential for health; negative dimensions of marital functioning have indirect influences on health outcomes through depression and health habits, and direct influences on cardiovascular, endocrine, immune, neurosensory, and other physiological mechanisms. Moreover, individual difference variables such as trait hostility augment the impact of marital processes on biological systems. Emerging themes in the past decade include the importance of differentiating positive and negative dimensions of marital functioning, the explanatory power of behavioral data, and gender differences in the pathways from the marital relationship to physiological functioning. Contemporary models of gender that emphasize self-processes, traits, and roles furnish alternative perspectives on the differential costs and benefits of marriage for men's and women's health.

Marriage and health: his and hers.

1.0 BACKGROUND ACTIGRAPHY HAS BEEN USED TO STUDY SLEEP/WAKE PATTERNS FOR OVER 20 YEARS. The advantage of actigraphy over traditional polysomnography (PSG) is that actigraphy can conveniently record continuously for 24-hours a day for days, weeks or even longer. In 1995, Sadeh et al.,1 under the auspices of the American Sleep Disorders Association (now called the American Academy of Sleep Medicine, AASM), reviewed the current knowledge about the role of actigraphy in the evaluation of sleep disorders. They concluded that actigraphy does provide useful information and that it may be a “cost-effective method for assessing specific sleep disorders...[but that] methodological issues have not been systematically addressed in clinical research and practice.” Based on that task force’s report, the AASM Standards of Practice Committee concluded that actigraphy was not indicated for routine diagnosis or for assessment of severity or management of sleep disorders, but might be a useful adjunct for diagnosing insomnia, circadian rhythm disorders or excessive sleepiness.2 Since that time, actigraph technology has improved, and many more studies have been conducted. Several review papers have concluded that wrist actigraphy can usefully approximate sleep versus wake state during 24 hours and have noted that actigraphy has been used for monitoring insomnia, circadian sleep/wake disturbances, and periodic limb movement disorder.3,4 This paper begins where the 1995 paper left off. Under the auspices of the AASM, a new task force was established to review the current state of the art of this technology.

The Role of Actigraphy in the Study of Sleep and Circadian Rhythms AMERICAN ACADEMY OF SLEEP MEDICINE REVIEW PAPER

Here I argue that addicted people become unable to make drug-use choices on the basis of long-term outcome, and I propose a neural framework that explains this myopia for future consequences. I suggest that addiction is the product of an imbalance between two separate, but interacting, neural systems that control decision making: an impulsive, amygdala system for signaling pain or pleasure of immediate prospects, and a reflective, prefrontal cortex system for signaling pain or pleasure of future prospects. After an individual learns social rules, the reflective system controls the impulsive system via several mechanisms. However, this control is not absolute; hyperactivity within the impulsive system can override the reflective system. I propose that drugs can trigger bottom-up, involuntary signals originating from the amygdala that modulate, bias or even hijack the goal-driven cognitive resources that are needed for the normal operation of the reflective system and for exercising the willpower to resist drugs.

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Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective

Ambulatory blood pressure and heart rate responses were obtained in 33 male paramedics during a &hour work shift to examine the effects of episodes of occupational stress on cardiovascular reactivity and subjective reports of stress. The aim of this study was to determine how individual differences in cynical hostility and defensiveness interacted with situational demands to affect cardiovascular responses in a natural setting. Defensiveness was found to interact significantly with cynical hostility in predicting subjects' heart rate responses in different work contexts. Specifically, in a hospital setting involving interpersonal conflict, subjects who were high in both defensiveness and hostility showed heart rate responses approximately do bpm higher than subjects who were high in hostility but low in defensiveness. I The same pattern of relationships was obtained for diastolic blood pressure. High and low hostile subjects were also found to differ from each other in their daily mean levels of ambulatory blood pressure during awake and sleep periods. These findings obtained in a natural setting lend further support to the significance of cynical hostility for cardiovascular reactivity. The results for defensiveness suggest the need for further research on the role of conflicting attitudes in the pathophysiology of cardiovascular diseases.

Ambulatory blood pressure and heart rate in paramedics: effects of cynical hostility and defensiveness.

Background and Purpose—The relationship between blood pressure (BP) and heart rate (HR) and MRI assessments of subcortical T2 hyperintensities was evaluated in healthy elderly men and women. Methods—Casual and 24-hour ambulatory BPs and HR measurements were taken of 144 elderly individuals, aged 55 to 79 years. Subjects had no evidence of previous health disorders. MRI scans of white matter, subcortical gray matter, and insular subcortex were coded for severity of hyperintensities. Results—Mean casual BP for the group was 120/72 mm Hg. With age and sex accounted for, individuals with the highest severity rating of white matter hyperintensities had higher casual, awake, and sleep systolic BPs; higher awake diastolic BPs; greater awake systolic BP variability; and a smaller nocturnal fall in systolic and diastolic BPs than individuals with less severe ratings. Higher severity ratings for subcortical gray matter hyperintensities were associated with elevations in casual, awake, and asleep systolic BPs and a ...

Relationship Between Blood Pressure and Subcortical Lesions in Healthy Elderly People

The objective of this study was to assess the relation between the intensity of single moods and of mood combinations on blood pressure (BP) and heart rate (HR). The subjects were 203 healthy registered nurses, all women, who were studied on two work and two off days. Ambulatory BP and HR were recorded every 20 min. On each occasion subjects rated their moods on a 5-point scale. Graded increases in BP and HR were shown with higher ratings of negative moods and decreases for a mood related to energy level. Little change was observed for a positive mood. These effects depended on concurrent changes in other moods. A positive mood countered the effects of a negative mood, whereas two negative moods resulted in unique patterns of BP and HR. The energy level mood moderated the cardiovascular effects of positive and negative moods. Ambulatory methods provide a way of probing into the nature and consequences of everyday emotional experiences.

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Striking a chord: moods, blood pressure, and heart rate in everyday life.

ObjectiveThis study examined women's cardiovascular and neuroendocrine responsiveness to work.MethodsAmbulatory blood pressure (BP) and heart rate (HR) were recorded over 24-hour periods on 2 work and 2 off days during the luteal and follicular phases of the menstrual cycle in 138 registered nurses,

Ambulatory blood pressure, heart rate, and neuroendocrine responses in women nurses during work and off work days.

Objective: To determine if initial values of casual and ambulatory systolic blood pressure (SBP) predict white matter hyperintensities, insular subcortex hyperintensities, and brain atrophy 5 years later in a group of healthy elderly individuals. Methods: The authors studied 155 healthy men and women, aged 55 to 79 years. Two 24-hour ambulatory blood pressure (BP) sessions assessed BP level and variability during waking and sleep. Hyperintensities and total brain volume were quantified by MRI. Procedures were repeated 5 years later in 78% (121) of subjects. Results: Hyperintensities and brain atrophy increased over time, with greater increases among older subjects. The presence of increased BP level and variability initially and again 5 years later had negative consequences for the brain. Independent of age, the greater the initial SBP, the greater the likelihood that individuals would have severe white matter hyperintensities after 5 years. Also, elevated casual SBP was associated with severe insular subcortex hyperintensities and greater SBP sleep variability with increased brain atrophy. Conclusions: Among healthy elderly individuals whose initial, average, casual blood pressure (BP) was relatively low (116.9/71.1 mm Hg), small increases in casual and 24-hour ambulatory BP measures were associated with greater brain atrophy and subcortical lesions after 5 years.

Iris B. Goldstein

Papers

Ambulatory blood pressure and heart rate in paramedics: effects of cynical hostility and defensiveness.

Relationship Between Blood Pressure and Subcortical Lesions in Healthy Elderly People

Striking a chord: moods, blood pressure, and heart rate in everyday life.

Ambulatory blood pressure, heart rate, and neuroendocrine responses in women nurses during work and off work days.

Ambulatory blood pressure and the brain A 5-year follow-up