Skip to main content
SpringerLink
Log in

From Ecological Momentary Assessment (EMA) to Ecological Momentary Intervention (EMI): Past and Future Directions for Ambulatory Assessment and Interventions in Eating Disorders

  • Eating Disorders (S Wonderlich and S Engel, Section Editors)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Ambulatory assessment methods, including ecological momentary assessment (EMA), have often been used in eating disorders (EDs) to assess the type, frequency, and temporal sequencing of ED symptoms occurring in naturalistic environments. Relatedly, growing research in EDs has explored the utility of ecological momentary interventions (EMIs) to target ED symptoms. The aims of the present review were to (1) synthesize recent literature pertaining to ambulatory assessment/EMA and EMI in EDs, and (2) identify relevant limitations and future directions in these domains.

Recent Findings

With respect to ambulatory assessment and EMA, there has been substantial growth in the expansion of constructs assessed with EMA, the exploration of state- vs. trait-level processes, integration of objective and passive assessment approaches, and consideration of methodological issues. The EMI literature in EDs also continues to grow, though most of the recent research focuses on mobile health (mHealth) technologies with relatively minimal EMI components that adapt to momentary contextual information.

Summary

Despite these encouraging advances, there remain several promising areas of ambulatory assessment research and clinical applications in EDs going forward. These include integration of passive data collection, use of EMA in treatment evaluation and design, evaluation of dynamic system processes, inclusion of diverse samples, and development and evaluation of adaptive, tailored EMIs such as just-in-time adaptive interventions. While much remains to be learned in each of these domains, the continual growth in mobile technology has potential to facilitate and refine our understanding of the nature of ED psychopathology and ultimately improve intervention approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Engel SG, Crosby RD, Thomas G, Bond D, Lavender JM, Mason T, et al. Ecological momentary assessment in eating disorder and obesity research: a review of the recent literature. Curr Psychiatry Rep. 2016;18(4):37.

    Article  PubMed  Google Scholar 

  2. Aardoom JJ, Dingemans AE, Van Furth EF. E-health interventions for eating disorders: emerging findings, issues, and opportunities. Curr Psychiatry Rep. 2016;18(4):42.

    Article  PubMed  Google Scholar 

  3. Juarascio AS, Parker MN, Lagacey MA, Godfrey KM. Just-in-time adaptive interventions: a novel approach for enhancing skill utilization and acquisition in cognitive behavioral therapy for eating disorders. Int J Eat Disord. 2018;51(8):826–30.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Society for Ambulatory Assessment. 2019. http://ambulatory-assessment.org/.

  5. Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol. 2008;4:1–32.

    Article  PubMed  Google Scholar 

  6. Haedt-Matt AA, Keel PK. Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment. Psychol Bull. 2011;137(4):660–81.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Berner LA, Crosby RD, Cao L, Engel SG, Lavender JM, Mitchell JE, et al. Temporal associations between affective instability and dysregulated eating behavior in bulimia nervosa. J Psychiatr Res. 2017;92:183–90.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kolar DR, Huss M, Preuss HM, Jenetzky E, Haynos AF, Bürger A, et al. Momentary emotion identification in female adolescents with and without anorexia nervosa. Psychiatry Res. 2017;255:394–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Furtjes S, Seidel M, King JA, Biemann R, Roessner V, Ehrlich S. Rumination in anorexia nervosa: cognitive-affective and neuroendocrinological aspects. Behav Res Ther. 2018;111:92–8.

    Article  PubMed  Google Scholar 

  10. Kockler TD, Tschacher W, Santangelo PS, Limberger MF, Ebner-Priemer UW. Specificity of emotion sequences in borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls: an e-diary study. Borderline Personal Disord Emot Dysregul. 2017;4:26.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Keating L, Mills JS, Rawana JS. Momentary predictors of binge eating: an attachment perspective. Eat Behav. 2019;32:44–52.

    Article  PubMed  Google Scholar 

  12. Stevenson BL, Wilborn D, Kramer MP, Dvorak RD. Real-time changes in emotion regulation and loss of control eating. J Health Psychol. 2019. https://doi.org/10.1177/1359105318823242.

  13. Levinson CA, Sala M, Fewell L, Brosof LC, Fournier L, Lenze EJ. Meal and snack-time eating disorder cognitions predict eating disorder behaviors and vice versa in a treatment seeking sample: a mobile technology based ecological momentary assessment study. Behav Res Ther. 2018;105:36–42.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mason TB, Lavender JM, Wonderlich SA, Steiger H, Cao L, Engel SG, et al. Comfortably numb: the role of momentary dissociation in the experience of negative affect around binge eating. J Nerv Ment Dis. 2017;205(5):335–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. McEvoy PM, Watson H, Watkins ER, Nathan P. The relationship between worry, rumination, and comorbidity: evidence for repetitive negative thinking as a transdiagnostic construct. J Affect Disord. 2013;151(1):313–20.

    Article  PubMed  Google Scholar 

  16. Nolen-Hoeksema S, Watkins ER. A heuristic for developing transdiagnostic models of psychopathology: explaining multifinality and divergent trajectories. Perspect Psychol Sci. 2011;6(6):589–609.

    Article  PubMed  Google Scholar 

  17. Sala M, Brosof LC, Levinson CA. Repetitive negative thinking predicts eating disorder behaviors: a pilot ecological momentary assessment study in a treatment seeking eating disorder sample. Behav Res Ther. 2019;112:12–7.

    Article  PubMed  Google Scholar 

  18. Seidel M, Petermann J, Diestel S, Ritschel F, Boehm I, King JA, et al. A naturalistic examination of negative affect and disorder-related rumination in anorexia nervosa. Eur Child Adolesc Psychiatry. 2016;25(11):1207–16.

    Article  PubMed  Google Scholar 

  19. Selby EA, Anestis MD, Bender TW, Joiner TE Jr. An exploration of the emotional cascade model in borderline personality disorder. J Abnorm Psychol. 2009;118(2):375–87.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Watkins ER, Nolen-Hoeksema S. A habit-goal framework of depressive rumination. J Abnorm Psychol. 2014;123(1):24–34.

    Article  PubMed  Google Scholar 

  21. Wildes JE, Marcus MD. Incorporating dimensions into the classification of eating disorders: three models and their implications for research and clinical practice. Int J Eat Disord. 2013;46(5):396–403.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Culbert KM, Lavender JM, Crosby RD, Wonderlich SA, Engel SG, Peterson CB, et al. Associations between negative affect and binge/purge behaviors in women with anorexia nervosa: considering the role of negative urgency. Compr Psychiatry. 2016;66:104–12.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fischer S, Wonderlich J, Breithaupt L, Byrne C, Engel S. Negative urgency and expectancies increase vulnerability to binge eating in bulimia nervosa. Eat Disord. 2018;26(1):39–51.

    Article  PubMed  Google Scholar 

  24. Goldschmidt AB, Smith KE, Lavender JM, Engel SG, Haedt-Matt A. Trait-level facets of impulsivity and momentary, naturalistic eating behavior in children and adolescents with overweight/obesity. J Psychiatr Res. 2019;110:24–30.

    Article  PubMed  Google Scholar 

  25. Pak KN, Wonderlich J, le Grange D, Engel SG, Crow S, Peterson C, et al. The moderating effect of impulsivity on negative affect and body checking. Compr Psychiatry. 2018;86:137–42.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Smith KE, Mason TB, Crosby RD, Engel SG, Wonderlich SA. A multimodal, naturalistic investigation of relationships between behavioral impulsivity, affect, and binge eating. Appetite. 2019;136:50–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Fuller-Tyszkiewicz M, Richardson B, Lewis V, Smyth J, Krug I. Do women with greater trait body dissatisfaction experience body dissatisfaction states differently? An experience sampling study. Body Image. 2018;25:1–8.

    Article  PubMed  Google Scholar 

  28. Smith KE, Mason TB, Crosby RD, Engel SG, Crow SJ, Wonderlich SA, et al. State and trait positive and negative affectivity in relation to restraint intention and binge eating among adults with obesity. Appetite. 2018;120:327–34.

    Article  PubMed  Google Scholar 

  29. •• Ranzenhofer LM, Engel SG, Crosby RD, et al. Real-time assessment of heart rate variability and loss of control eating in adolescent girls: a pilot study. Int J Eat Disord. 2016;49(2):197–201. This study was one of the few studies to examine intra-individaul variability in objective ambulatory assessments, which integrated EMA and ambulatory HRV assessment to identify within-person effects of HRV on loss-of-control eating among adolescents.

    Article  PubMed  Google Scholar 

  30. Mason TB, Engwall A, Mead MP, Irish LA. Sleep and eating disorders among adults enrolled in a commercial weight loss program: associations with self-report and objective sleep measures. Eat Weight Disord. 2019;24:307–12.

    Article  PubMed  Google Scholar 

  31. Wonderlich JA, Breithaupt LE, Crosby RD, Thompson JC, Engel SG, Fischer S. The relation between craving and binge eating: integrating neuroimaging and ecological momentary assessment. Appetite. 2017;117:294–302.

    Article  PubMed  Google Scholar 

  32. Wonderlich JA, Breithaupt L, Thompson JC, Crosby RD, Engel SG, Fischer S. The impact of neural responses to food cues following stress on trajectories of negative and positive affect and binge eating in daily life. J Psychiatr Res. 2018;102:14–22.

    Article  PubMed  Google Scholar 

  33. •• Fischer S, Breithaupt L, Wonderlich J, et al. Impact of the neural correlates of stress and cue reactivity on stress related binge eating in the natural environment. J Psychiatr Res. 2017;92:15–23. This study was the first study in eating disorders to examine the extent to which neural activations measured by fMRI influence symptoms measured via EMA.

    Article  PubMed  Google Scholar 

  34. Seidel M, King JA, Ritschel F, Boehm I, Geisler D, Bernardoni F, et al. The real-life costs of emotion regulation in anorexia nervosa: a combined ecological momentary assessment and fMRI study. Transl Psychiatry. 2018;8(1):28.

    Article  PubMed  PubMed Central  Google Scholar 

  35. •• Kockler TD, Santangelo PS, Ebner-Priemer UW. Investigating binge eating using ecological momentary assessment: the importance of an appropriate sampling frequency. Nutrients. 2018;10(1). This article highlighted key methodological issues regarding sampling frequency in EMA eating disroder research.

    Article  PubMed Central  Google Scholar 

  36. •• Berg KC, Cao L, Crosby RD, et al. Negative affect and binge eating: reconciling differences between two analytic approaches in ecological momentary assessment research. Int J Eat Disord. 2017;50(10):1222–30. This study compared two commomly used analytic techniques used to assess affect trajectories surrounding eating disorder behaviors.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Goldschmidt AB, Crosby RD, Cao L, Wonderlich SA, Mitchell JE, Engel SG, et al. A preliminary study of momentary, naturalistic indicators of binge-eating episodes in adults with obesity. Int J Eat Disord. 2018;51(1):87–91.

    Article  PubMed  Google Scholar 

  38. Sultson H, Kukk K, Akkermann K. Positive and negative emotional eating have different associations with overeating and binge eating: construction and validation of the positive-negative emotional eating scale. Appetite. 2017;116:423–30.

    Article  PubMed  Google Scholar 

  39. Mason TB, Smith KE, Crosby RD, Wonderlich SA, Crow SJ, Engel SG, et al. Does the eating disorder examination questionnaire global subscale adequately predict eating disorder psychopathology in the daily life of obese adults? Eat Weight Disord. 2018;23(4):521–6.

    Article  PubMed  Google Scholar 

  40. Mason TB, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Crow SJ, et al. Associations among eating disorder behaviors and eating disorder quality of life in adult women with anorexia nervosa. Psychiatry Res. 2018;267:108–11.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Smyth JM, Zawadzki MJ, Juth V, Sciamanna CN. Global life satisfaction predicts ambulatory affect, stress, and cortisol in daily life in working adults. J Behav Med. 2017;40(2):320–31.

    Article  PubMed  Google Scholar 

  42. O’Connor SG, Habre R, Bastain TM, et al. Within-subject effects of environmental and social stressors on pre- and post-partum obesity-related biobehavioral responses in low-income Hispanic women: protocol of an intensive longitudinal study. BMC Public Health. 2019;19(1):253.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Boushey CJ, Spoden M, Zhu FM, Delp EJ, Kerr DA. New mobile methods for dietary assessment: review of image-assisted and image-based dietary assessment methods. Proc Nutr Soc. 2017;76(3):283–94.

    Article  CAS  PubMed  Google Scholar 

  44. Migueles JH, Cadenas-Sanchez C, Ekelund U, Delisle Nyström C, Mora-Gonzalez J, Löf M, et al. Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations. Sports Med. 2017;47(9):1821–45.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lillie EO, Patay B, Diamant J, Issell B, Topol EJ, Schork NJ. The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Perinat Med. 2011;8(2):161–73.

    Google Scholar 

  46. McDonald S, Quinn F, Vieira R, O’Brien N, White M, Johnston DW, et al. The state of the art and future opportunities for using longitudinal n-of-1 methods in health behaviour research: a systematic literature overview. Health Psychol Rev. 2017;11(4):307–23.

    Article  PubMed  Google Scholar 

  47. Borsboom D. A network theory of mental disorders. World Psychiatry. 2017;16(1):5–13.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Nelson B, McGorry PD, Wichers M, Wigman JTW, Hartmann JA. Moving from static to dynamic models of the onset of mental disorder: a review. JAMA Psychiatry. 2017;74(5):528–34.

    Article  PubMed  Google Scholar 

  49. Bringmann LF, Vissers N, Wichers M, Geschwind N, Kuppens P, Peeters F, et al. A network approach to psychopathology: new insights into clinical longitudinal data. PLoS One. 2013;8(4):e60188.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Wichers M, Wigman JTW, Myin-Germeys I. Micro-level affect dynamics in psychopathology viewed from complex dynamical system theory. Emot Rev. 2015;7(4):362–7.

    Article  Google Scholar 

  51. Goldschmidt AB, Smith KE, Crosby RD, Boyd HK, Dougherty E, Engel SG, et al. Ecological momentary assessment of maladaptive eating in children and adolescents with overweight or obesity. Int J Eat Disord. 2018;51(6):549–57.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Connelly K, Stein KF, Chaudry B, Trabold N. Development of an ecological momentary assessment mobile app for a low-literacy, Mexican American population to collect disordered eating behaviors. JMIR Public Health Surveill. 2016;2(2):e31.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Heron KE, Smyth JM. Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol. 2010;15(1):1–39.

    Article  PubMed  Google Scholar 

  54. Shingleton RM, Palfai TP. Technology-delivered adaptations of motivational interviewing for health-related behaviors: a systematic review of the current research. Patient Educ Couns. 2016;99(1):17–35.

    Article  PubMed  Google Scholar 

  55. Lindgreen P, Clausen L, Lomborg K. Clinicians’ perspective on an app for patient self-monitoring in eating disorder treatment. Int J Eat Disord. 2018;51(4):314–21.

    Article  PubMed  Google Scholar 

  56. Lindgreen P, Lomborg K, Clausen L. Patient experiences using a self-monitoring app in eating disorder treatment: qualitative study. JMIR Mhealth Uhealth. 2018;6(6):e10253.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Kim JP, Sadeh-Sharvit S, Darcy AM, et al. The utility and acceptability of a self-help smartphone application for eating disorder behaviors. J Technol Behav Sci. 2018;3:1–4.

    Article  Google Scholar 

  58. •• Anastasiadou D, Folkvord F, Lupianez-Villanueva F. A systematic review of mHealth interventions for the support of eating disorders. Eur Eat Disord Rev. 2018;26(5):394–416. This review summarizes the literature to date on mobile health technology in eating disorders.

    Article  PubMed  Google Scholar 

  59. Mazzeo SE, Lydecker J, Harney M, Palmberg AA, Kelly NR, Gow RW, et al. Development and preliminary effectiveness of an innovative treatment for binge eating in racially diverse adolescent girls. Eat Behav. 2016;22:199–205.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Hildebrandt T, Michaelides A, Mackinnon D, Greif R, DeBar L, Sysko R. Randomized controlled trial comparing smartphone assisted versus traditional guided self-help for adults with binge eating. Int J Eat Disord. 2017;50(11):1313–22.

    Article  PubMed  PubMed Central  Google Scholar 

  61. •• Juarascio AS, Goldstein SP, Manasse SM, Forman EM, Butryn ML. Perceptions of the feasibility and acceptability of a smartphone application for the treatment of binge eating disorders: qualitative feedback from a user population and clinicians. Int J Med Inform. 2015;84(10):808–16. This article describes the development of an ecological momentary intervention for binge eating diorders.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015;17(2):e52.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Versluis A, Verkuil B, Spinhoven P, van der Ploeg MM, Brosschot JF. Changing mental health and positive psychological well-being using ecological momentary interventions: a systematic review and meta-analysis. J Med Internet Res. 2016;18(6):e152.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Nahum-Shani I, Hekler EB, Spruijt-Metz D. Building health behavior models to guide the development of just-in-time adaptive interventions: a pragmatic framework. Health Psychol. 2015;34S:1209–19.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Bio-behavioral Research, Sanford Research, Fargo, ND, USA

    Kathryn E. Smith

  2. Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA

    Kathryn E. Smith

  3. Department of Psychology, Drexel University, Philadelphia, PA, USA

    Adrienne Juarascio

Authors
  1. Kathryn E. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adrienne Juarascio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn E. Smith.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Eating Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, K.E., Juarascio, A. From Ecological Momentary Assessment (EMA) to Ecological Momentary Intervention (EMI): Past and Future Directions for Ambulatory Assessment and Interventions in Eating Disorders. Curr Psychiatry Rep 21, 53 (2019). https://doi.org/10.1007/s11920-019-1046-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-019-1046-8

Keywords

Search

Navigation