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'I feel better when…': An analysis of the memory-experience gap for peoples' estimates of the relationship between health behaviours and experiences
Psychology & Health
Abstract
Objective: People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as “my mood is better when I exercise”. This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour.
Design: Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments.
Main Outcome Measures: University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period.
Results: Correlations between experiences and behaviours (online data) were small (r = −.12–.14), estimated correlations moderate (r = −.35–.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity.
Conclusion: Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy.
... However, these estimates are themselves averages of instability over time and do not directly deal with the timing and sequences of momentary mental experiences. Likewise, some studies suggest that individuals may overestimate how much different mental and behavioral phenomena covary (that is, go together in time) for them (Gloster et al., 2008;Gloster, Meyer, Witthauer, Lieb, & Mata, 2017;Shiffman et al., 1997). However, in general, comparisons between retrospectively assessed and contemporaneously assessed momentary information are few. ...
... However, recognition of the dynamic covariation of stress and self-esteem (including how self-esteem and stress states are linked to one another and to themselves across 15-min intervals) was poor. This finding is consistent with prior studies suggesting systematic discrepancies between the actual within-person covariance of different states and events and individuals' estimation of this covariance (Gloster et al., 2008;Gloster et al., 2017). The current results suggest that individuals do not perceive and encode these dynamics accurately, giving the experience sampling method (along with within-person analyses) a clear advantage when it comes to uncovering the actual dynamic processes among different mental states, events, and behaviors. ...
... This is in line with prior research suggesting that retrospective ratings of means and general frequencies are less prone to inaccuracy than information about change and instability (Ebner-Priemer, Bohus, & Kuo, 2007, as cited in Ebner-Priemer & Trull, 2009Stone et al., 2004). This finding also echoes research suggesting disagreements between the actual covariance of events and mental states and individuals' estimates of this covariation (Gloster et al., 2008;Gloster et al., 2017;Shiffman et al., 1997). That participants were not only inaccurate in the current study but also biased (in the sense that they recalled more lagged, dynamic relations between stress and selfesteem and underestimated the inertia in these two states) suggests that this inaccuracy may reflect participants' intuitive or folk-psychological Note. ...
The experience sampling method (ESM) is often used in research, and promoted for clinical use, with the rationale that it avoids problematic inaccuracies and biases that attend retrospective measures of mental phenomena. Research suggests that averaged scores from ESM data are more accurate than retrospective ratings. However, it is not known how well individuals can remember information about momentary (rather than averaged) mental states, nor how accurately they estimate the dynamic covariation of these states. Individual differences in retrospective accuracy are also poorly understood. In two pre-registered studies, we examined differences between retrospective memory for stress and self-esteem and data gathered via experience sampling and examined whether alexithymia predicted accuracy. Results of both studies revealed substantial discrepancies between retrospective ratings and ESM ratings, especially for momentary states and their covariation. Alexithymia was positively related to recognition of stress means and variability but unrelated to recall of either stress or self-esteem, their variability, or their covariation. These findings suggest that experience sampling may be more useful than self-report when precise information is needed about the timing of mental states and dynamics among them.
... However, the obvious limitation with relying on patient perceptions is that patients often lack insight into the causal relations between their symptoms, especially for effects on longer time scales and perhaps especially before therapy. Indeed, it has been shown that respondents often overestimate causation between behavioral phenomena (Gloster et al., 2017). Also, common clinical experience suggests that patients are often unaware of how their behaviors, context, and emotions influence one another (Ghaemi & Rosenquist, 2004;Medalia & Thysen, 2008;Peralta & Cuesta, 1998) and retrospective biases might impact PECAN assessments (Van den Bergh & Walentynowicz, 2016). ...
Addressing the persistent heterogeneity in psychopathology, treatment outcomes, and the science–practice gap requires a systematic approach to personalizing psychotherapy. Case conceptualization seeks to understand a patient’s unique psychopathology by generating and continuously updating hypotheses about predisposing, precipitating, and maintaining factors. This study introduces a new data-driven method to formalize this process with personalized network estimation, combining prior elicitation and Bayesian inference. It is the first to test its clinical usefulness with 12 patients, primarily treated for depression, and their therapists (preregistered and can be found as the additional online materials: https://osf.io/38qdx). Patients employed the Perceived Causal Networks method to create personalized “prior networks,” mapping how they perceived their symptoms to interact. Bayesian inference was used to update these prior networks using longitudinal data collected subsequently 6 times daily over 15 days (N = 935), resulting in personalized “posterior networks.” Both Perceived Causal Networks and longitudinal assessments were evaluated as feasible and acceptable. Face validity was scored highest for the posterior networks. Patients emphasized the personal relevance of these networks, while therapists noted their value in guiding the therapeutic process. However, prior, posterior, and data networks showed significant dissimilarities. These differences may stem from patients’ limited insight into symptom interactions, insufficient power in the longitudinal data, or variations in self-perception. Despite some inconsistencies, the study shows potential for combining two methods to create personalized models of psychopathology, highlighting the need for future research to refine this formalization process into a more rigorous theoretical-empirical cycle to test these models.
... However, the obvious limitation with relying on patient perceptions is that patients often lack insight into the causal relations between their symptoms, especially for effects on longer time scales and perhaps especially before therapy. Indeed, it has been shown that respondents often overestimate causation between behavioral phenomena (Gloster et al., 2017). Also, common clinical experience suggests that patients are often unaware of how their behaviors, context, and emotions influence one another (Ghaemi & Rosenquist, 2004;Medalia & Thysen, 2008;Peralta & Cuesta, 1998) and retrospective biases might impact PECAN assessments (Van den Bergh & Walentynowicz, 2016). ...
Addressing the persistent heterogeneity in psychopathology, treatment outcomes, and the science-practice gap requires a systematic approach to personalizing psychotherapy. Case conceptualization aims to understand a patient’s idiographic psychopathology by generating hypotheses about predisposing, precipitating, and maintaining factors. These hypotheses are continually updated with new information from assessments and ongoing treatment. This study applies a novel data-driven approach to formalize this process with personalized network estimation through prior elicitation and Bayesian inference. It is the first study to assess the clinical utility of this approach in a sample of twelve psychotherapy patients, primarily treated for depression, along with their respective therapists (preregistered: https://osf.io/38qdx).Patients employed the PECAN (Perceived Causal Networks) method to create personalized "prior networks," mapping how they perceived their symptoms to interact. Intensive longitudinal data were then collected six times daily over 15 days (N = 935). Bayesian inference was used to update these prior networks using the collected longitudinal data, resulting in personalized "posterior networks."Both PECAN and longitudinal assessments were evaluated feasible and acceptable. Face validity was scored highest for the posterior networks. Patients emphasized the personal relevance of these networks, while therapists noted their value in guiding the therapeutic process. However, prior, posterior, and data networks showed significant dissimilarities. These differences may stem from patients’ limited insight into symptom interactions, insufficient power in the longitudinal data, or variations in self-perception. Despite these discrepancies, this study demonstrates the potential for integrating two methods to create personalized models of psychopathology. Future research should refine this formalization process to develop a more rigorous theoretical-empirical cycle to test these models.
... Third, the causality ratings in the PECAN are likely to be systematically biased. Indeed, people tend to overestimate causality between behavioral phenomena (Gloster et al., 2017). This bias likely works in different directions for different behavior and emotions, so that respondents might overestimate how much insomnia causes concentration problems, and underestimate how much lack of exercise causes feeling tired. ...
Personalized case conceptualization is often regarded as a prerequisite for treatment success in psychotherapy for patients with comorbidity. This article presents Perceived Causal Networks, a novel method in which patients rate perceived causal relations among behavioral and emotional problems. First, 231 respondents screening positive for depression completed an online Perceived Causal Networks questionnaire. Median completion time (including repeat items to assess immediate test–retest reliability) was 22.7 minutes, and centrality measures showed excellent immediate test–retest reliability. Networks were highly idiosyncratic, but worrying and ruminating were the most central items for a third of respondents. Second, 50 psychotherapists rated the clinical utility of Perceived Causal Networks visualizations. Ninety-six percent rated the networks as clinically useful, and the information in the individual visualizations was judged to contain 47% of the information typically collected during a psychotherapy assessment phase. Future studies should individualize networks further and evaluate the validity of perceived causal relations.
... suggest that individuals have a bias towards recalling their experiences, especially their negative experiences, as more intense and persistent than they actually were (Ben-Zeev et al. 2012Ellison et al. 2020;Kelly et al. 2019;Urban et al. 2018;Wenze et al. 2012), and they overestimate the links between their symptoms and stressful circumstances (Ellison et al. 2020;Gloster et al. 2017Gloster et al. , 2008. These inaccuracies and biases threaten the accuracy and efficiency of diagnoses and case formulations based on clients' retrospective accounts. ...
Ecological momentary assessment (EMA) is a burgeoning area of research, and several clinical applications of the resulting data have been identified by researchers, suggesting potential benefit to psychotherapy practice. However, practitioners often do not use traditional empirically-supported tools for diagnosis and outcome monitoring (e.g., validated interview measures and questionnaires). Thus, it is not clear how readily practitioners will take up newer technology-enhanced assessment methods, despite current enthusiasm among researchers. The current study aimed to explore the perceived usefulness of EMA-based tools for clinical assessment and outcome monitoring of difficult psychotherapy cases, as well as to identify correlates of attitudes about the usefulness of these tools. Clinical psychologists in active therapy practice with adults (n = 375) completed an internet survey including the Attitudes toward Standardized Assessment scale and the Attitudes toward Standardized Assessment Scales-Monitoring and Feedback. Respondents characterized their current diagnostic and outcome monitoring practices and rated how helpful they would find several assessment and outcome monitoring resources for a difficult case, including both traditional instruments and EMA-based methods. EMA-based tools had lower perceived usefulness than existing instruments. Attitudes toward standardized assessment and outcome monitoring predicted the perceived utility of these methods, as did several professional variables. Practicing psychologists may not adopt EMA for clinical assessment more readily than traditional assessment tools. Recommendations for facilitating the uptake of new technologies by psychotherapists are offered.
... By capturing treatment effectiveness (including follow-up to 12 months), symptoms, emotions, social interactions, stressors, psychological flexibility, spreading of effects to the patient's social network, well-being, and health-behaviors as well as behavioral variables, and fluctuations of all these, this study will add to the understanding of antecedents, consequences, and inherent processes that contribute to the recovery of psychological disorders and maintenance of gains as well as fluctuations in well-being, functioning and reduced symptomatology. Furthermore, these data allow for a better understanding how time affects the accuracy of participants' reporting of their own experiences, thereby contributing to a better understanding of how to better probe for such information in the future [49]. Therefore, these data are relevant for both basic clinical theory and clinical care. ...
Background:
Acceptance and Commitment Therapy (ACT) has been successfully established in hundreds of efficacy trials. It is less understood, however, how ACT works in real-world settings. Furthermore, little is known about how contextual variables such as treatment setting (inpatient vs. outpatient), social network and environment of the patient impact outcome.
Methods:
This paper describes the methods of the Choose Change study that compares transdiagnostic inpatients (n = 85) and outpatients (n = 85) with varying degrees of treatment experience and treatment success (i.e., no previous treatment vs. previous remission vs. treatment-resistant). Patients received ACT during an intensive treatment phase lasting approximately twelve treatment sessions, and were accompanied up to twelve months following intensive treatment. Main outcomes include symptoms, functioning, and well-being. Multiple levels of data are investigated, including treatment context, weekly assessments, a behavioral approach test, multiple follow-up phases, and ambulatory assessment using Event Sampling Methodology, to examine patients' daily context.
Discussion:
We aim to investigate antecedents, consequences, and inherent processes that contribute to the maintenance or fluctuations of psychological disorders and the efficacy of ACT treatment. Furthermore, this study intends to increase understanding of how accurately participants can report on their own experiences, in order to expand our knowledge of how to probe for such information in the future. The results of Choose Change will provide basic clinical theory and clinical care with important and meaningful insights into the effectiveness of ACT, trans diagnostically, in in- and outpatients, and in a naturalistic setting.
Trial registration:
This study was retrospectively registered in the ISRCTN Registry (registration number ISRCTN11209732 ) on May 20th 2016.
... By capturing the fluctuations of symptoms, emotions, social interactions, well-being, and health-behaviours as well as neuropsychological and biological variables, we can contribute to the understanding of antecedents, consequences, and inherent processes that give rise to these fluctuations. These data also allow us to test how well participants can accurately report on their own experiences, thereby increasing understanding of how to better probe for such information in research and the clinic(Gloster, Meyer, Witthauer, Lieb, & Mata, 2017). These data are thus relevant for basic clinical theory and clinical care alike.By using ESM, we were able to capture experiences in participants' naturally chosen context thereby generating fundamentally different type of knowledge than questionnaires (i.e. ...
Background and objectives:
Acceptance and Commitment Therapy (ACT), a behavioral therapy that targets psychological flexibility (PF), has been shown to be efficacious across a wide range of problems, including chronic work-related stress and perceived stress. ACT's effect on the multiple levels of the acute stress response (i.e., subjective and biological) is less well understood. The aim of the current study was to test whether ACT, by working toward PF, would reduce both the endocrine and subjective evaluations of participants' acute stress response.
Methods:
Participants (n = 35) were randomized to an ACT condition or waitlist (WL). Participants in the ACT condition received a two-day ACT workshop on how to flexibly deal with stress. All participants completed a standardized laboratory stress test.
Results:
The ACT and WL groups did not differ on main comparisons of the endocrine response (i.e., cortisol) or subjective evaluation. Baseline levels of PF moderated some outcomes. Avoidant participants had a stronger endocrine stress reaction if they received the ACT intervention.
Limitations:
The control condition was a WL and not an active intervention comparison.
Conclusions:
ACT is not useful in reducing the acute stress response and may even be iatrogenic, at least during tasks with little real-world impact for their personal values.
We examined the mood-related and pain-related consequences of daily stressors among 74 individuals with rheumatoid arthritis who supplied daily reports for 75 days. Meta-analyses of time series regression coefficients disclosed a significant same-day relation between events and mood but no consistent effects of events on same-day pain, next-day mood, or next-day pain. With distributional characteristics of the daily data controlled, Ss with more active inflammatory disease showed a greater positive relation of events with same-day and next-day pain, those with a recent history of more major life stressors showed a greater positive relation of events with next-day pain, and those with less social support showed a greater positive relation of events with next-day mood disturbance. Implications of these and other findings for theories of stress and adaptation and the methodological challenges of daily experience research are discussed.
Research on people's confidence in their general knowledge has to date produced two fairly stable effects, many inconsistent results, and no comprehensive theory. We propose such a comprehensive framework, the theory of probabilistic mental models (PMM theory). The theory (a) explains both the overconfidence effect (mean confidence is higher than percentage of answers correct) and the hard–easy effect (overconfidence increases with item difficulty) reported in the literature and (b) predicts conditions under which both effects appear, disappear, or invert. In addition, (c) it predicts a new phenomenon, the confidence–frequency effect, a systematic difference between a judgment of confidence in a single event (i.e., that any given answer is correct) and a judgment of the frequency of correct answers in the long run. Two experiments are reported that support PMM theory by confirming these predictions, and several apparent anomalies reported in the literature are explained and integrated into the present framework.
This review organizes a variety of phenomena related to emotional self-report. In doing so, the authors offer an accessibility model that specifies the types of factors that contribute to emotional self-reports under different reporting conditions. One important distinction is between emotion, which is episodic, experiential, and contextual, and beliefs about emotion, which are semantic, conceptual, and decontextualized. This distinction is important in understanding the discrepancies that often occur when people are asked to report on feelings they are currently experiencing versus those that they are not currently experiencing. The accessibility model provides an organizing framework for understanding self-reports of emotion and suggests some new directions for research.
Pleasure and displeasure can be parsed into anticipatory and consummatory phases. However, research on pleasure and displeasure in major depressive disorder (MDD), a disorder characterized by anhedonia, has largely focused on deficits in the consummatory phase. Moreover, most studies in this area have been laboratory-based, raising the question of how component processes of pleasure and displeasure are experienced in the daily lives of depressed individuals. Using experience sampling, we compared anticipatory and consummatory pleasure and displeasure for daily activities reported by adults with MDD (n = 41) and healthy controls (n = 39). Participants carried electronic devices for one week and were randomly prompted eight times a day to answer questions about activities to which they most and least looked forward. Compared to healthy controls, MDD participants reported blunted levels of both anticipatory and consummatory pleasure and elevated levels of both anticipatory and consummatory displeasure for daily activities. Independent of MDD status, participants accurately predicted pleasure but overestimated displeasure. These results are the first to provide evidence that, across both anticipatory and consummatory phases, individuals with MDD experience blunted pleasure and elevated displeasure for daily activities. Our findings clarify the disturbances in pleasure and displeasure that characterize MDD and may inform treatment for this debilitating disorder. (PsycINFO Database Record
Two studies were conducted to test the predictions of a multi-component model of distinctiveness-based illusory correlation (IC) regarding the use of episodic and evaluative information in the production of the phenomenon. Extending on the standard paradigm, participants were presented with 4 groups decreasing in size, but all exhibiting the same ratio of positive to negative behaviours. Study 1 (N = 75) specifically tested the role of group size and distinctiveness, by including a zero-frequency cell in the design. Consistent with predictions drawn from the proposed model, with decreasing group size, the magnitude of the IC effect showed a linear increase in judgments thought to be based on evaluative information. In Study 2 (N = 43), a number of changes were introduced to a group assignment task (double presentation, inclusion of decoys) that allowed a more rigorous test of the predicted item-specific memory effects. In addition, a new multilevel, mixed logistic regression approach to signal-detection type analysis was used, providing a more flexible and reliable analysis than previously. Again, with decreasing group size, IC effects showed the predicted monotonic increase on the measures (group assignment frequencies, likability ratings) thought to be dependent on evaluative information. At the same time, measures thought to be based on episodic information (free recall and group assignment accuracy) partly revealed the predicted enhanced episodic memory for smaller groups and negative items, while also supporting a distinctiveness-based approach. Additional analysis revealed that the pattern of results for judgments though to be based on evaluative information was independent of interpersonal variation in behavioral memory, as predicted by the multi-component model, and in contrast to predictions of the competing models. The results are discussed in terms of the implications of the findings for the proposed mechanisms of illusory correlation.
Objective
This intensive longitudinal study examined how sleep and physical activity relate to university students’ affect and academic performance during a stressful examination period.
Methods
On 32 consecutive days, 72 first-year students answered online questionnaires on their sleep quality, physical activity, positive and negative affect, learning goal achievement, and examination grades. First-year university students are particularly well-suited to test our hypotheses: They represent a relatively homogeneous population in a natural, but controlled setting, and simultaneously deal with similar stressors, such as examinations. Data were analyzed using multilevel structural equation models.
Results
Over the examination period, better average sleep quality but not physical activity predicted better learning goal achievement. Better learning goal achievement was associated with increased probability of passing all examinations. Relations of average sleep quality and average physical activity with learning goal achievement were mediated by experienced positive affect. In terms of day-to-day dynamics, on days with better sleep quality, participants reported better learning goal achievement. Day-to-day physical activity was not related to daily learning goal achievement. Daily positive and negative affect both mediated the effect of day-to-day sleep quality and physical activity on daily learning goal achievement.
Conclusion
Health behaviors such as sleep quality and physical activity seem important for both academic performance and affect experience, an indicator of mental health, during a stressful examination period. These results are a first step toward a better understanding of between- and within-person variations in health behaviors, affect, and academic performance, and could inform prevention and intervention programs for university students.
The affective changes associated with acute exercise have been studied extensively in exercise and health psychology, but not in affective psychology. This paper presents a summary of the relevant findings and a tentative theoretical model. According to this model, affective responses to exercise are jointly influenced by cognitive factors, such as physical self-efficacy, and interoceptive (e.g., muscular or respiratory) cues that reach the affective centres of the brain via subcortical routes. Furthermore, the balance between these two determinants is hypothesised to shift as a function of exercise intensity, with cognitive factors being dominant at low intensities and interoceptive cues gaining salience as intensity approaches the individual's functional limits and the maintenance of a physiological steady-state becomes impossible.
In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
This study is a systematic review of the Alameda County study findings and their importance in establishing a link between lifestyle and health outcomes. A systematic review of literature was performed and data indicating important links between lifestyle and health were synthesized. Although initial studies focused on the associations between health outcomes and personal health habits known as the "Alameda 7," subsequent studies focused on the relationships between social variables, religiosity, several chronic health problems, and long-term health. Significant findings during periodic assessments of the original 1965 cohort yielded strong support for a link between lifestyle habits and long-term health outcomes. Additionally, social networks, religiosity, and several demographic variables were found to be associated with chronic disease development.
The design of an individualized treatment program in behavior therapy is critical, complex, and strongly affected by pretreatment data obtained as part of a multimethod, multimodal assessment. The functional analysis is the integration of several elements for individualized treatment decision making: the relative importance, interrelationships, and sequelae of a client's behavior problems and treatment goals and the relative modifiability, interrelationships, and strength of causal variables. The functional analysis can be represented visually with the functional analytic clinical case model (FACCM), a vector-graphic representation of variables and functional relationships. This article describes and illustrates the methods, rationale, and characteristics of both the functional analysis and the FACCM, using a clinical case example. Research and restrictions on the treatment utility of the functional analysis are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Recent research suggests that retrospective coping assessments may not correspond well with day-to-day reports. The authors extended this work by examining the correspondence between short-term (within 48 hr) retrospective coping reports and momentary reports recorded via a palm-top computer close in time to when the stressor occurred. There was relatively poor correspondence between the 2 assessments. Some reports of momentary coping were not reported retrospectively, and some coping reported retrospectively was not reported at the time the stressor occurred. Cognitive coping was more likely to be underreported retrospectively; behavioral coping was overreported. Participants were consistent in their discrepancies, but there was no correspondence between discrepancy rates and demographic or personality variables. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this article, we review the differences between momentary, retrospective, and trait self-report techniques and discuss the unique role that ambulatory reports of momentary experience play in psychosomatic medicine. After a brief historical review of self-report techniques, we discuss the latest perspective that links ambulatory self-reports to a qualitatively different conscious self-the "experiencing self"--which is functionally and neuroanatomically different from the "remembering" and "believing" selves measured through retrospective and trait questionnaires. The experiencing self functions to navigate current environments and is relatively more tied to the salience network and corporeal information from the body that regulates autonomic processes. As evidence, we review research showing that experiences measured through ambulatory assessment have stronger associations with cardiovascular reactivity, cortisol response, immune system function, and threat/reward biomarkers compared with memories or beliefs. By contrast, memories and beliefs play important roles in decision making and long-term planning, but they are less tied to bodily processes and more tied to default/long-term memory networks, which minimizes their sensitivity for certain research questions. We conclude with specific recommendations for using self-report questionnaires in psychosomatic medicine and suggest that intensive ambulatory assessment of experiences may provide greater sensitivity for connecting psychological with biologic processes.
ObjectiveThe purpose of this meta-analysis was to examine the effect of acute aerobic exercise on self-reported positive-activated affect (PAA). Samples from 158 studies from 1979 to 2005 were included yielding 450 independent effect sizes (ESs) and a sample size of 13,101.MethodStudies were coded for moderators related to assessment time, exercise variables such as intensity, duration, and dose (combination of intensity and duration), and design characteristics. The analysis considered multiple measures of affect and corrected for statistical artifacts using Hunter and Schmidt [(1990). Methods of meta-analysis: Correcting error and bias in research findings. Newbury Park: Sage; (2004). Methods of meta-analysis: Correcting error and bias in research findings (2nd ed.). Thousand Oaks: Sage] meta-analytic methods.ResultsThe overall estimated mean corrected ES () and standard deviation (SDcorr) were .47 and .37, respectively. Effects were consistently positive (a) immediately post-exercise, (b) when pre-exercise PAA was lower than average, (c) for low intensity exercise <15–39% oxygen uptake reserve (%VO2R), (d) for durations up to 35 min, and (e) for low to moderate exercise doses. The effects of aerobic exercise on PAA appear to last for at least 30 min after exercise before returning to baseline. Dose results suggest the presence of distinct zones of affective change that more accurately reflect post-exercise PAA responses than intensity or duration alone. Control conditions were associated with reductions in PAA (, SDcorr=.25).ConclusionThe typical acute bout of aerobic exercise produces increases in self-reported PAA, whereas the typical control condition produces decreases. However, large SDcorr values suggest that additional variables, possibly related to individual differences, further moderate the effects of exercise on PAA.
Researchers have argued that the investigation of causal interrelationships between symptoms may help explain the high comorbidity rate between certain psychiatric disorders. Clients’ own attributions concerning the causal interrelationships linking the co-occurrence of their symptoms represent data that may inform their clinical case conceptualization, treatment, and psychological theory regarding the etiology of comorbid disorders. The present study developed and evaluated a novel psychological assessment methodology for measuring Perceived Causal Relations (PCR) and examined its psychometric properties as applied to the question of whether posttraumatic stress and anxiety symptoms represent causal risk factors for depressive symptoms in 225 undergraduates. Participants attributed their symptoms of anxiety and posttraumatic reexperiencing as significant causes of their depressive symptoms. Exploratory analyses identified a listing of symptoms reliably attributed as significant causes of other symptoms and functional impairment, as well as a listing of symptoms reliably attributed as significant effects (outcomes) of other symptoms and functional impairment. The PCR method has promise as an idiographic approach to assessing the causes and consequences of comorbid psychiatric symptoms and associated functional impairment. Research is required to assess the relevance and replicate these findings in distinct psychiatric groups experiencing various symptomatic presentations. Future research may also examine PCR ratings associating other individual differences, for example, between measures of history (e.g., life events), life choices, and personality.
Although prescribed exercise has been found to improve affect and reduce levels of depression, we do not know how self-initiated everyday physical activity influences levels of positive affect (PA) and negative affect (NA) in depressed persons. Fifty-three individuals diagnosed with Major Depressive Disorder (MDD) and 53 never-depressed controls participated in a seven-day experience sampling study. Participants were prompted randomly eight times per day and answered questions about their physical activity and affective state. Over the week, the two groups of participants did not differ in average level of physical activity. As expected, participants with MDD reported lower average PA and higher average NA than did never-depressed controls. Both participants with MDD and controls reported higher levels of PA at prompts after physical activity than at prompts after inactive periods; moreover, for both groups of participants, PA increased from a prompt after an inactive period to a subsequent prompt at which activity was reported. Depressed participants in particular showed a dose-response effect of physical activity on affect: longer duration and/or higher intensity of physical activity increased their PA significantly more than did short duration and/or lower intensity physical activity. Physical activity did not influence NA in either group. In contrast to previous treatment studies that examined the effects of prescribed structured exercise, this investigation showed that self-initiated physical activity influences PA. These findings also underscore the importance of distinguishing between PA and NA to gain a more comprehensive understanding of the effects of physical activity on affect in MDD.
Intense pain is often exaggerated in retrospective evaluations, indicating a possible divergence between experience and memory. However, little is known regarding how people retrospectively evaluate experiences with both pleasant and unpleasant aspects. The Day Reconstruction Method (DRM; Kahneman. Krueger, Schkade, Schwarz, & Stone, 2004b) provides a unique opportunity to examine memory-experience gaps in recollections of individual days, which elicit a wide gamut of emotions. We asked female participants (N = 810, Study 1, and N = 615, Study 2) to reconstruct episodes of the previous day using the DRM and demonstrated that memory and experience diverge for both pleasant and unpleasant emotions. When they rated their day overall in a retrospectively evaluative frame of mind, the participants recalled more unpleasant and pleasant emotions than they reported feeling during the individual episodes, with a larger gap for unpleasant emotions than for pleasant emotions. The findings suggest that separate processes are used for committing positive and negative events to memory and that, especially when unpleasant emotions are involved, prudence is favored over accuracy.
In this review, we discuss ecological momentary assessment (EMA) studies on mood disorders and mood dysregulation, illustrating 6 major benefits of the EMA approach to clinical assessment: (a) Real-time assessments increase accuracy and minimize retrospective bias; (b) repeated assessments can reveal dynamic processes; (c) multimodal assessments can integrate psychological, physiological, and behavioral data; (d) setting- or context-specific relationships of symptoms or behaviors can be identified; (e) interactive feedback can be provided in real time; and (f) assessments in real-life situations enhance generalizability. In the context of mood disorders and mood dysregulation, we demonstrate that EMA can address specific research questions better than laboratory or questionnaire studies. However, before clinicians and researchers can fully realize these benefits, sets of standardized e-diary questionnaires and time sampling protocols must be developed that are reliable, valid, and sensitive to change.
I examined correlates of Negative Affect (NA) and Positive Affect (PA) through both within- and between-subjects analyses. Eighty subjects completed a daily questionnaire for 6-8 weeks. Each day they rated (a) their mood, (b) the extent to which they suffered from various minor physical problems, (c) their level of stress, (d) the time they spent socializing, and (e) whether or not they had exercised. Subjects also completed several trait tests measuring their general affective level, frequency of health problems, and social tendencies. A between-subjects analysis showed the expected pattern: Level of physical complaints and perceived stress were correlated with individual differences in NA but not in PA, whereas social indicators and frequency of exercise were related only to PA. The within-subjects results generally exhibited a similar pattern: Social activity and exercise were more strongly related to PA, whereas perceived stress was highly related to NA. However, the most significant finding was that, contrary to prediction, health complaints were as strongly related to intraindividual fluctuations in PA as in NA. Possible interpretations of the observed correlates of NA and PA are discussed.
Research and treatment assessments often rely on retrospective recall of events. The accuracy of recall was tested using accounts of smoking lapse episodes from 127 participants who had quit smoking, and lapses and temptations were recorded in near-real time using a hand-held computer. These computer records were compared with retrospective accounts elicited 12 weeks later, with a focus on recall of lapses in 4 content domains: mood, activity, episode Triggers, and abstinence violation effects. Recall of lapses was quite poor: Average kappas for items ranged from 0.18 to 0.27. Mean profile rs assessing recall for the overall pattern of behavior were .36, .30, .33, and .44 for these domains, respectively. In recall, participants overestimated their negative affect and the number of cigarettes they had smoked during the lapse, and their recall was influenced by current smoking status. The findings suggest caution in the use of recall in research and intervention.
The discrepancy between retrospective and prospective rating of anxiety symptoms and cognition was examined in 20 agoraphobics. Subjects were required to complete a checklist of symptoms and cognitions during exposure to an agoraphobic situation. and then to complete a similar set retrospectively. More cognitions were rated retrospectively than prospectively, with the discrepancy especially evident for cognitions about physical catastrophe. In contrast, there was no discrepancy between anxiety symptoms rated prospectively versus retrospectively. This may be because anxiety symptoms are easier for patients to identify than cognitions. require less introspection. or are less affected by context than cognition. Implications of the findings are discussed and suggestions for future research are made.
This review organizes a variety of phenomena related to emotional self-report. In doing so, the authors offer an accessibility model that specifies the types of factors that contribute to emotional self-reports under different reporting conditions. One important distinction is between emotion, which is episodic, experiential, and contextual, and beliefs about emotion, which are semantic, conceptual, and decontextualized. This distinction is important in understanding the discrepancies that often occur when people are asked to report on feelings they are currently experiencing versus those that they are not currently experiencing. The accessibility model provides an organizing framework for understanding self-reports of emotion and suggests some new directions for research.
To better understand the association between pain recalled over a previous week and the average of multiple momentary reports of pain taken during the same period, 68 patients with chronic pain completed both weekly recall and momentary reports over a 2-week period and assessed their change in pain over the 2 weeks. Pearson correlations and intraclass correlation coefficients were computed to index three different ways of comparing the measures on both a between-person and within-person basis. Between-person correspondence between weekly and momentary reports was generally moderate to high, but within-person correspondence was low. Judged change was only weakly related to changes over a week computed from weekly recall or from average momentary reports. Given the importance of within-person change for treatment studies, these results indicate a serious nonequivalence in weekly recall and averaged momentary reports of pain.
The aim of this prospective quasi-experimental study was to assess the role of coping style as a factor moderating the relationship between stress and sleep. Sleep of 36 students was assessed by means of actigraphy and daily logs during low-stress and high-stress periods. The high-stress period was the week that the students were evaluated for acceptance to graduate programs in clinical psychology. The low-stress period was a regular academic week. The students' ways of coping were assessed during the baseline low-stress period using the COPE inventory. Data analysis revealed that a high emotion-focused coping score was significantly predictive of reduction in sleep time from the low- to the high-stress period. These results suggest that coping style is a key factor in assessing the relationship between stress and sleep.
The Day Reconstruction Method (DRM) assesses how people spend their time and how they experience the various activities and settings of their lives, combining features of time-budget measurement and experience sampling. Participants systematically reconstruct their activities and experiences of the preceding day with procedures designed to reduce recall biases. The DRM's utility is shown by documenting close correspondences between the DRM reports of 909 employed women and established results from experience sampling. An analysis of the hedonic treadmill shows the DRM's potential for well-being research.
Download link at: http://sitemaker.umich.edu/norbert.schwarz/day_reconstruction_method__time_use____well-being
Stressors have a major influence upon mood, our sense of well-being, behavior, and health. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. However, if the threat is unremitting, particularly in older or unhealthy individuals, the long-term effects of stressors can damage health. The relationship between psychosocial stressors and disease is affected by the nature, number, and persistence of the stressors as well as by the individual's biological vulnerability (i.e., genetics, constitutional factors), psychosocial resources, and learned patterns of coping. Psychosocial interventions have proven useful for treating stress-related disorders and may influence the course of chronic diseases.
Change is constant in everyday life. Infants crawl and then walk, children learn to read and write, teenagers mature in myriad ways, and the elderly become frail and forgetful. Beyond these natural processes and events, external forces and interventions instigate and disrupt change: test scores may rise after a coaching course, drug abusers may remain abstinent after residential treatment. By charting changes over time and investigating whether and when events occur, researchers reveal the temporal rhythms of our lives. This book is concerned with behavioral, social, and biomedical sciences. It offers a presentation of two of today's most popular statistical methods: multilevel models for individual change and hazard/survival models for event occurrence (in both discrete- and continuous-time). Using data sets from published studies, the book takes you step by step through complete analyses, from simple exploratory displays that reveal underlying patterns through sophisticated specifications of complex statistical models.
This guidance describes how the FDA evaluates patient-reported outcome (PRO) instruments used as effectiveness endpoints in clinical trials. It also describes our current thinking on how sponsors can develop and use study results measured by PRO instruments to support claims in approved product labeling (see appendix point 1). It does not address the use of PRO instruments for purposes beyond evaluation of claims made about a drug or medical product in its labeling. By explicitly addressing the review issues identified in this guidance, sponsors can increase the efficiency of their endpoint discussions with the FDA during the product development process, streamline the FDA's review of PRO endpoint adequacy, and provide optimal information about the patient's perspective of treatment benefit at the time of product approval.
A PRO is a measurement of any aspect of a patient's health status that comes directly from the patient (i.e., without the interpretation of the patient's responses by a physician or anyone else). In clinical trials, a PRO instrument can be used to measure the impact of an intervention on one or more aspects of patients' health status, hereafter referred to as PRO concepts, ranging from the purely symptomatic (response of a headache) to more complex concepts (e.g., ability to carry out activities of daily living), to extremely complex concepts such as quality of life , which is widely understood to be a multidomain concept with physical, psychological, and social components. Data generated by a PRO instrument can provide evidence of a treatment benefit from the patient perspective. For this data to be meaningful, however, there should be evidence that the PRO instrument effectively measures the particular concept that is studied. Generally, findings measured by PRO instruments may be used to support claims in approved product labeling if the claims are derived from adequate and well-controlled investigations that use PRO instruments that reliably and validly measure the specific concepts at issue.
The glossary defines many of the terms used in this guidance. In particular, the term instrument refers to the actual questions or items contained in a questionnaire or interview schedule along with all the additional information and documentation that supports the use of these items in producing a PRO measure (e.g., interviewer training and instructions, scoring and interpretation manual). The term conceptual framework refers to how items are grouped according to subconcepts or domains (e.g., the item walking without help may be grouped with another item, walking with difficulty , within the domain of ambulation , and ambulation may be further grouped into the concept of physical ability ).
FDA's guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidance documents describe the Agency's current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited. The use of the word should in Agency guidance documents means that something is suggested or recommended but not required.
First publication of the Draft Guidance by the Food and Drug Administration- February 2006.
People base many decisions on affective forecasts, predictions about their emotional reactions to future events. They often display an impact bias, overestimating the intensity and duration of their emotional reactions to such events. One cause of the impact bias is focalism, the tendency to underestimate the extent to which other events will influence our thoughts and feelings. Another is people's failure to anticipate how quickly they will make sense of things that happen to them in a way that speeds emotional recovery. This is especially true when predicting reactions to negative events: People fail to anticipate how quickly they will cope psychologically with such events in ways that speed their recovery from them. Several implications are discussed, such as the tendency for people to attribute their unexpected resilience to external agents.
This chapter provides a review of recent research on distinctiveness-based illusory correlations and spurious correlations in biased stereotype formation, with a particular focus on the commonalities of the two phenomena. In particular, we critically analyse the impact of episodic memory for specific events on biased stereotype formation, and we investigate the role of salient context factors for contingency learning and stereotypic inference. The reviewed findings question some traditional assumptions concerning the origins of illusory and spurious correlations, which largely relied on the very specifics of the experimental paradigms that produced the effects. The findings are, however, compatible with more integrative theoretical frameworks that allow one to subsume biased stereotypes on the basis of illusory and spurious correlations together with several other judgement biases. Associationistic learning models and pseudo-contingencies are proposed as promising conceptual frameworks.
Sleep interventions have rarely explored reductions in night-to-night fluctuations [i.e. intra-individual variability (IIV)] in sleep, despite the negative impacts of such fluctuations on affective states and cognitive and physical symptoms. In a community-based randomized controlled trial we evaluated whether physical exercise reduced IIV in self-rated sleep outcomes among middle-aged and older adults with sleep complaints. Under-active adults 55 years and older (n = 66, 67% women) with mild to moderate sleep complaints were randomized to 12 months of a moderate-intensity endurance exercise (n = 36) or a health education control group (n = 30). Daily sleep logs, Pittsburgh Sleep Quality Index (PSQI) and in-home polysomnographic sleep recordings (PSG) were collected at baseline, 6 months and 12 months. Sleep log-derived means and IIV were computed for sleep-onset latency (SOL), time in bed, feeling rested in the morning, number of nighttime awakenings, and wake after final awakening (WAFA). Using intent-to-treat methods, at 6 months no differences in IIV were observed by group. At 12 months, SOL-based IIV was reduced in the exercise group compared with the control (difference = 23.11, 95% CI: 3.04-47.18, P = 0.025, Cohen's d = 0.57). This change occurred without mean-level or IIV changes in sleep-wake schedules. For all sleep variables, except SOL and WAFA, IIV changes and mean-level changes in each variable were negatively correlated (r = -0.312 to -0.691, P < 0.05). Sleep log-derived IIV changes were modestly correlated with mean-level PSQI and PSG-based changes at 12 months. Twelve months of moderate-intensity exercise reduced night-to-night fluctuations in self-rated time to fall asleep, and this relationship was independent of mean-level time to fall asleep.
A growing body of literature suggests that retrospective recall of psychiatric symptoms is often inaccurate and may distort knowledge about the course of illness and impact treatment. The current study examined the accuracy of retrospective recall of a variety of depressive symptoms in hospitalized depressed patients and nonclinical controls. Using the Experience Sampling Method, we compared average momentary symptom reports of 1 week to retrospective summaries of the same period. The depressed group exhibited negative biases in their recall of experienced anhedonia, sadness, confusion, and suicidality, but were relatively accurate in recall of helplessness, detachment, and self-control. Controls exhibited a different pattern; they were relatively accurate in their retrospective recall of confusion, suicidality and sadness, but exhibited positive biases in recall of anhedonia, helplessness, detachment, and self-control. Both groups exhibited comparable negative biases in their recall of experienced tension, difficulty concentrating, guilt, and fear. The findings suggest that for maximum accuracy in the assessment of depressive symptoms, scientists and practitioners should supplement retrospective self-reports with momentary measures, and consider using ambulatory assessment in cognitive behavioral treatments of depression.
An event sampling method was used to study the frequency of panic attacks during treatment of agoraphobics. Results revealed a much lower incidence of panic attacks in agoraphobics according to self-monitoring than was expected on account of their retrospective estimation. When more stringent criteria for panic attacks are applied, retrospective overestimation becomes even more apparent. The implication of this finding for the classification of panic disorder patients is discussed.
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety.
The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months.
The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition.
While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.
The tendency to experience negative emotions in the face of stress may lead to repeated overactivation of the hypothalamic-pituitary-adrenal axis. In a sample of 556 women, this study used the Experience Sampling Method to assess different daily stressors, current mood, and salivary cortisol, 10 times daily for 5 days. Multilevel analyses estimated the contributions of stressors and mood states as predictors of salivary cortisol secretion. Results showed that minor stressors were associated with decreased positive affect and increased negative affect, agitation, and cortisol. Of the mood states, only negative affect was independently associated with cortisol. Negative affect also mediated effects of daily stressors on cortisol. Although further research is needed to clarify: (i) the causal pathways between daily stress, mood, and cortisol and (ii) the importance of daily stress reactivity as a prospective risk factor, these findings confirm that minor daily stressors can influence emotional and biological processes involved in subjective well-being.
When people report somatic complaints retrospectively, they depend on their memory. Therefore, retrospective reports can be influenced by general beliefs on sickness and health from semantic memory. We hypothesized that individuals with medically unexplained symptoms (MUS) would have recall biases stronger than those of people without complaints when reporting symptoms retrospectively, and that this effect would be a function of time between symptom experience and report.
To compare two time frames, 37 participants who were high and low on MUS reported momentary symptoms combined by daily recall and weekly recall using an electronic diary.
Both groups reported more symptoms when recalling the entire week than what could be expected from average momentary reports. However, participants high on MUS also reported more symptoms when recalling a week than when recalling a day. For this group, recall bias was not associated with peak heuristic or symptoms variability.
Symptom reports in people high on MUS increases as time passes by, probably as a results of a shift in memory retrieval strategy from using episodic knowledge to using semantic beliefs.
Assessment methods relying on biased or inaccurate retrospective recall may distort knowledge about the nature of disorders and lead to faulty clinical inferences. Despite concerns about the accuracy of retrospective recall in general and in particular with obsessive-compulsive disorder (OCD) patients, the accuracy of retrospective recall for one's own symptoms assessed in vivo is unknown in this population. This study used a prospective ecological momentary assessment (EMA) methodology to create a criterion against which to assess recall accuracy in OCD patients. Although results indicated that patients' retrospective recall of OCD symptoms was fairly accurate, they consistently overestimated the magnitude of OCD symptom covariation with non-OCD facets (e.g., sleep duration, contemporaneous stress level, etc.). Findings suggest that even when recall of OCD symptoms is accurate, patients may be inaccurate in estimating symptom covariation. The findings have implications for the research, case conceptualization, and assessment of OCD, and may extend to other disorders.
This pilot study evaluated the feasibility of ecologic momentary assessment (EMA) to measure five eating disorder behaviors and to examine reactivity of these behaviors to this measurement approach. The pattern of correspondence between EMA and the Eating Disorder Examination (EDE) was also examined.
Women with threshold or subthreshold anorexia and bulimia nervosa (N=16) recorded their eating disorder behaviors for 4 weeks on a hand-held computer. Upon completion of the EMA procedure, the EDE was administered.
Eighty-eight percent of the sample completed the EMA behavioral recording. No differences in behavioral frequency were found in the first and second halves of the EMA measurement period, suggesting that behaviors were not reactive to the methodology. Binging and excessive exercise were lower when measured by EMA compared with the EDE.
These results suggest that EMA is a feasible and valid approach to the measurement of disordered eating behaviors.
Intraindividual variability in positive and negative affect: Age-related and individual differences in magnitude and coupling with cognitive performance
- C Roecke
Trends in Ambulatory Self-Report
- T S Conner
- L F Barrett