Michael F. Armey

Changes in ecological momentary assessment reported affect associated with episodes of nonsuicidal self-injury.

Although emotion regulation deficits have been frequently implicated in the incidence of nonsuicidal self-injurious behavior (NSSI), no research to date has examined in vivo change of affect associated with real-world NSSI behavior. The present study employed Ecological Momentary Assessment (EMA) to assess change in affect associated with episodes of experienced NSSI in a sample of 36 college students with a self-reported history of NSSI. Results indicated that individuals who reported NSSI behavior over the course of the study experienced increases in negative affect prior to an episode of NSSI that peaked during the episode and faded gradually in the hours following the episode, with affect change roughly approximating a quadratic curve. These changes in affect were detected only at times in which individuals engaged in NSSI and were absent for individuals who did not report NSSI over the course of the study. Moreover, changes in negative affect associated with NSSI were, on average, detectable hours prior to the NSSI event. These findings suggest that episodes of NSSI may be predicted through a careful examination of affect change long before actual NSSI behavior occurs.

Brooding and Pondering: Isolating the active ingredients of depressive rumination with exploratory factor analysis and structural equation modeling

Depressive rumination, as assessed by Nolen-Hoeksema’s Response Styles Questionnaire (RSQ), predicts the onset, chronicity, and duration of depressed mood. However, some RSQ items contain depressive content and result in a heterogeneous factor structure. After the a priori elimination of items potentially confounded with depressed item content, Treynor, Gonzalez, and Nolen-Hoeksema identified two factors within the remaining RSQ rumination sub-scale that were differentially related to depression: brooding and pondering. However, Treynor et al. used a nonstandard form and administration of the RSQ. The present study sought to address these methodological idiosyncrasies and replicate the factor structure of Treynor et al. through exploratory factor analysis and structural equation modeling. Findings support the brooding and pondering solution and demonstrate that brooding relates more strongly to depression and anxiety than does pondering.

A comparison of linear versus non-linear models of aversive self-awareness, dissociation, and non-suicidal self-injury among young adults.

Research has identified a significant increase in both the incidence and prevalence of non-suicidal self-injury (NSSI). The present study sought to test both linear and non-linear cusp catastrophe models by using aversive self-awareness, which was operationalized as a composite of aversive self-relevant affect and cognitions, and dissociation as predictors of NSSI. The cusp catastrophe model evidenced a better fit to the data, accounting for 6 times the variance (66%) of a linear model (9%-10%). These results support models of NSSI implicating emotion regulation deficits and experiential avoidance in the occurrence of NSSI and provide preliminary support for the use of cusp catastrophe models to study certain types of low base rate psychopathology such as NSSI. These findings suggest novel approaches to prevention and treatment of NSSI as well.

The point prevalence of bulimic disorders from 1990 to 2004.

OBJECTIVE This study investigated the point prevalence of probable cases of bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), and specific eating disorder symptomatology among 6,844 undergraduate women at a single site, examining changes across five 3-year time periods and on a yearly basis from 1990 to 2004. METHOD Participants completed a self-report checklist that assessed the diagnostic criteria for BN (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 1994) and the Bulimia Test (Smith and Thelen, J Consult Clin Psychol, 52, 863-872, 1984) (BULIT) or Bulimia Test-Revised (Thelen et al., Psychol Assess, 3, 119-124, 1991) (BULIT-R). RESULTS Chi-square analyses comparing the percentages of probable cases of BN and EDNOS and the percentages of women who reported frequent binge eating and most compensatory weight control strategies were nonsignificant. Only the percentages of women who endorsed overconcern with weight and shape and diuretic use and excessive exercise as compensatory weight control strategies changed over time. CONCLUSION Consistent with Keel et al.s (Keel et al., Psychol Med, 36, 119-127, 2006) findings regarding the point prevalence rates of BN from 1992 to 2002, results indicated that probable cases of eating disorders remained relatively stable. Methodologically, this research illustrates the importance of examining multiple data points when investigating stability or change in behavior.

Feasibility and Acceptability of a Mobile Intervention to Improve Treatment Adherence in Bipolar Disorder: A Pilot Study.

We evaluated the feasibility and acceptability of a 2-week-long ecological momentary intervention (EMI), delivered via personal digital assistants (PDAs), to improve treatment adherence in bipolar disorder. EMIs use mobile technology to deliver treatment as clients engage in their typical daily routines, in their usual settings. Overall, participants (N = 14) stated that EMI sessions were helpful, user-friendly, and engaging, and reported satisfaction with the timing and burden of sessions, as well as the method of delivery. All participants completed the study, and all PDAs were returned undamaged. On average, participants completed 92% of EMI sessions. Although this study was not designed to assess efficacy, depression scores decreased significantly over the study period and data suggest relatively high rates of treatment adherence; missed medication was reported 3% of the time and three participants reported missing a total of six mental health appointments. Negative feedback largely involved technical and logistical issues, many of which are easily addressable. These preliminary findings add to the growing body of literature indicating that mobile-technology-assisted interventions are feasible to implement and acceptable to patients with serious mental illnesses.

Ecological Momentary Assessment and Intervention in Nonsuicidal Self-Injury: A Novel Approach to Treatment

This study provides an introduction to ecological momentary assessment (EMA) methods and the potential use of ecological momentary intervention (EMI) for nonsuicidal self-injury (NSSI). The novel use of EMA and EMI are discussed within the context of the emotion regulation function of NSSI, the ability of these approaches to complement established treatments (i.e., cognitive behavior therapy & dialectical behavior therapy), and the specific areas in which an EMI treatment approach can augment traditional treatment. Based on established EMA findings in general and specific applications of EMA to the NSSI, a model EMI for NSSI is proposed.

Emotional reactivity monitoring using electrodermal activity analysis in individuals with suicidal behaviors

Suicide, considered as one of the leading causes of death, has not been given enough attention in order to reduce its rate. The problem addressed in this paper is the analysis of the relation between an extra stimulus and physiological datas responses. In order to record the physiological data set from multiple subjects over many weeks, we used an acoustic startle during a Paced Auditory Serial Addition Task (PASAT) test that spontaneously leads subjects to real emotional reactivity, without any deliberate laboratory setting. Crucially, we show that, by inducing anxiety during the test, changes appear in Electrodermal activity, Electrocardiogram, Heart Rate and Respiration Rate. A wide range of physiological features from various analysis domains, including modeling, time/frequency analysis, an algorithm and etc., is proposed in order to find the best emotional reactivity feature to correlate them with emotional states which can be considered as a suicide factor. More specifically, this paper is focused on the EDA data analysis. Experimental results highlight that all cited techniques perform well and we achieved a high resolution of tonic and phasic components which allow us to measure the latency, onsets and amplitudes of EDA responses to a stimulus. This paper follows the association of recommendations for advancement of health care instruments.

An Open Trial of a Smartphone-assisted, Adjunctive Intervention to Improve Treatment Adherence in Bipolar Disorder

We evaluated the feasibility and acceptability of a novel, 12-week, adjunctive, smartphone-assisted intervention to improve treatment adherence in bipolar disorder. Eight participants completed 4 in-person individual therapy sessions over the course of a month, followed by 60 days of twice-daily ecological momentary intervention (EMI) sessions, with a fifth in-person session after 30 days and a sixth in-person session after 60 days. Perceived credibility of the intervention and expectancy for change were adequate at baseline, and satisfaction on completion of the intervention was very high. Participants demonstrated good adherence to the intervention overall, including excellent adherence to the in-person component and fair adherence to the smartphone-facilitated component. Qualitative feedback revealed very high satisfaction with the in-person sessions and suggested a broad range of ways in which the EMI sessions were helpful. Participants also provided suggestions for improving the intervention, which primarily related to the structure and administration of the EMI (smartphone-administered) sessions. Although this study was not designed to evaluate treatment efficacy, most key outcome variables changed in the expected directions from pretreatment to posttreatment, and several variables changed significantly over the course of the in-person sessions or during the EMI phase. These findings add to the small but growing body of literature suggesting that EMIs are feasible and acceptable for use in populations with bipolar disorder.

An Exploratory Analysis of Situational Affect, Early Life Stress, and Nonsuicidal Self-Injury in College Students

Research and theory related to nonsuicidal self-injury (NSSI) have highlighted the potential role for early traumatic experiences in subsequent enactment of NSSI behaviors. The present investigation explores the impact of trauma type and timing on both (a) reported NSSI as traditionally measured and (b) in vivo NSSI assessments. Findings supported an interaction between negative affect (NA) and cumulative trauma, such that individuals with high levels of cumulative life trauma evidenced greater in vivo NSSI severity following both high and low levels of in vivo NA. Nonlinear cusp models further supported the presence of an interaction of trauma, particularly trauma prior to 6 years of age, and pre-NSSI NA in the prediction of in vivo NSSI episode severity. The present findings extend a developing literature related to the effects of early life experiences on health behavior.

The roles of social stress and decision-making in non-suicidal self-injury

Research suggests that individuals with a history of non-suicidal self-injury (NSSI) do not have difficulty generating alternatives to social problems but choose more negative solutions, suggesting a deficit in decision-making. However, studies report no significant differences in risky decision-making on a performance-based task among individuals with and without NSSI histories. A limitation of these studies is that decision-making was only assessed at baseline. As individuals with a history of NSSI typically self-injure when experiencing negative emotions, decision-making ability may become impaired specifically in the presence of these emotions. The aim of the current study was to investigate decision-making ability among individuals with and without NSSI histories both at baseline and following a distressing social exclusion task. We compared individuals with (n=48) and without (n=72) NSSI histories on the Iowa Gambling Task, a behavioral measure of risky decision-making, before and after exclusion or inclusion on the Cyberball task. Results indicated no significant group differences in performance regardless of condition. When participants were grouped by racial/ethnic minority status, results indicated that non-Hispanic White individuals with a history of NSSI exhibited deterioration in risky decision-making ability following social exclusion. Potential explanations for these findings and clinical implications are discussed.