With great interest, we read the recently published review on emotion regulation in binge eating disorder (BED) by Dingemans et al. [1].[...

Ebner-Priemer, Ulrich

Kockler, Tobias

Santangelo, Philip

Tobias Kockler

Multidisciplinary Digital Publishing Institute

Investigating Binge Eating Using Ecological Momentary Assessment: The Importance of an Appropriate Sampling Frequency

Tobias D. Kockler

Philip S. Santangelo

Ulrich W. Ebner-Priemer

Directory of Open Access Journals

Nutrients

Philip Santangelo

Ulrich Ebner-Priemer

Crossref

KITopen

nutrientsCommentaryInvestigating Binge Eating Using EcologicalMomentary Assessment: The Importance of anAppropriate Sampling FrequencyTobias D. Kockler * ID , Philip S. Santangelo ID and Ulrich W. Ebner-PriemerMental mHealth Lab, Karlsruhe Institute of Technology, 76187 Karlsruhe, Germany;philip.santangelo@kit.edu (P.S.S.); ulrich.ebner-priemer@kit.edu (U.W.E.-P.)* Correspondence: tobias.kockler@kit.edu; Tel.: +49-721-608-41976Received: 20 December 2017; Accepted: 17 January 2018; Published: 19 January 2018Keywords: binge eating; ecological momentary assessment; sampling frequencyWith great interest, we read the recently published review on emotion regulation in binge eatingdisorder (BED) by Dingemans et al. [1]. We fully agree with the authors that (a) in order to betterunderstand binge eating, it is of major importance to delineate its affective consequences; and (b)ecological momentary assessment (EMA) is the gold standard to track these affective dynamics inpatients’ everyday lives without retrospective distortions [2]. Whereas Dingemans et al. [1] aresurprised that empirical evidence supporting the theoretical models is inconclusive, yet all modelsassume a reduction of negative affect after binge eating episodes, we can provide a coherent explicationfor the lack of evidence—namely the sampling frequency.Most of the studies included in the meta-analysis reported by Dingemans and colleagues [2]tracked a highly dynamic process (affective consequences) using a low sampling frequency. However,a low sampling frequency is not able to capture rapid affective dynamics. In detail, the averagesampling frequency in the meta-analysis was approximately 7.8 times per day [3], which correspondsto one assessment every two hours during the waking time. Our case example (see Figure 1) depictsthe underlying velocity of affective dynamics.We extracted a 1.5-h time segment from an EMA study, in which we tracked patients withbulimia nervosa (BN)—among other disorders—every 15 min (±1 min) over a period of 24 h duringtheir waking time [4]. The extracted 1.5-h time segment covers seven separate assessments, andrevealed impressive dynamics. In detail, at 4:56 p.m., the patient reported interest as her predominantmomentary emotion, a positive emotional valence, and an urge to eat as well as an aversive tensionat a medium level. Fifteen minutes later, the patient switched to an angry mood state and intensenegative valence. At 5:26 p.m., she began with regular eating accompanied by the feeling of disgust,which then turned to loss-of-control binge eating at the next two assessment points until 5:58 p.m.While binge eating, the patient first felt disgust followed by anxiety. The urge to eat, aversive tension,and negative valence reached their climax in the middle of the eating episode. Whereas the urge to eatwas already decreasing at the end of the eating episode, the aversive tension declined immediatelyafterwards. Interestingly, this decline of tension was accompanied by a strong feeling of joy from6:12 p.m. to 6:26 p.m. We would have missed all these dynamics using a lower sampling frequency,such as one assessment every two hours or assessments just before and after binge eating episodes.Nutrients 2018, 10, 105; doi:10.3390/nu10010105 www.mdpi.com/journal/nutrientsNutrients 2018, 10, 105 2 of 3Nutrients 2018, 10, 105 2 of 3   Figure 1. Affective dynamics and eating behavior of a single patient with bulimia nervosa (BN) before, during, and after a binge eating episode. Valence constitutes the intensity of emotions rated on an 11-point Likert scale from 0–11, whereas the intensity rating was multiplied by −1 in the case of negative emotions; therefore, valence scores range from −11 to +11. Urge to eat and aversive tension were assessed on an 11-point Likert scale from 0–10, with higher values indicating a stronger urge to eat and stronger aversive tension, respectively. What applies to binge eating episodes also holds true for binge-purge episodes, which we provide an illustrative example of in Figure 2. During a 1.5-h binge-purge episode of another patient with BN, we see remarkable dynamics in “urge to eat” and “urge to vomit” accompanied by a transition from sadness to disgust at the beginning of the purging behavior. This is in line with Dingemans et al. [1], who conclude that binge eating episodes and binge-purge cycles may be different processes with specific affective dynamics.  Figure 2. Affective dynamics, eating behavior, and purging behavior of a single patient with bulimia nervosa (BN) before, during, and after a binge-purge episode. Valence constitutes the intensity of emotions rated on a 11-point Likert scale from 0–11, whereas the intensity rating was multiplied by −1 in the case of negative emotions; therefore, valence scores range from −11 to +11. Urge to eat and Figure 1. Affective dynamics and eating behavior of a single patient with bulimia nervosa (BN) before,during, and after a binge eating episode. Valence constitutes the intensity of emotions rated on an11-point Likert scale from 0–11, whereas the intensity rating was multiplied by −1 in the case ofnegative moti s; therefore, valence sc res range from −11 to +11. Urge to eat and aversiv ensionwere assessed on an 11-point Likert scale from 0–10, with higher values indicating a stronger urge toeat and stronger aversive tension, respectively.What applies to binge eating episodes also holds true for binge-purge episodes, which we providean illustrative example of in Figure 2. During a 1.5-h binge-purge episode f another pati nt with BN,we see remarkable dynamics in “urge to eat” a d “urge to v mit” accompanied b a transition fromsadness to disgust at the beginning of the purging behavior. This is in line with Dingemans et al. [1],who conclude that binge eating episodes and binge-purge cycles may be different processes withspecific affective dynamics.Nutrients 2018, 10, 105 2 of 3   Figure 1. Aff ctive dyn mi s and eating b avior of a single patient with b limia nervosa (BN) before,during, and fter a bing  eating episode. Valence constitut s the intensity of emotions rated on an 11-point Likert scale from 0–11, whereas th  intensity rating was multiplied by −1 in the case of negative emotions; therefore, valence scores range from −11 to +11. Urge to eat and aversive tension were assessed on an 11-poi t Likert scal  from 0–10, wit  highe  values indicating a stronger urge to eat and stronger aversive tension, respectively. What applies to binge eating episodes also olds true for binge-purge episodes, which e provide a  illustrative example of in Figure 2. During a 1.5-h binge-purge episode of another patient with BN, we see remarkable dynamics in “urge to eat” and “urge to vomit” accompanied by a transition from sadness to disgust at the beginning of the purging behavior. This is in line with Dingemans et al. [1], who conclude that binge eating episodes and binge-purge cycles may be different processes with specific affective dynamics.  Figure 2. Aff ctive dynamics, eating behavior and purging behavior f a single patient with bulimianervosa (BN) before, during, and after a binge-purge episode. Valence constitutes the intensity of emotions rated on a 11-point Likert scale from 0–11, whereas the intensity rating was multiplied by −1 in the case of negative emotions; therefore, valence scores range from −11 to +11. Urge to eat and Figure 2. Affective dynamics, eating behavior, and purging behavior of a single patient with bulimianervosa (BN) before, during, and after a binge-purge episode. Valence constitutes the intensity ofemotions rated on a 11-point Likert scale from 0–11, whereas the intensity rating was multiplied by−1 in the case of negative emotions; therefore, valence scores range from −11 to +11. Urge to eatand urge to vomit were assessed on a 11-point Likert scale from 0–10, with higher values indicating astronger urge.Nutrients 2018, 10, 105 3 of 3In summary, the sampling frequency must fit the dynamics of the process of interest in order toallow for valid conclusions [5]. Future EMA studies testing the theoretical models of BED may benefitfrom an appropriate sampling frequency.Author Contributions: T.D.K. contributed to the data management, developed the figures, and wrote the letter.P.S.S. contributed to the data management and helped to draft the manuscript. U.W.E.-P. conceived of thestudy, participated in its design and coordination, and wrote the letter. All authors read and approved thefinal manuscript.Conflicts of Interest: The authors declare no conflict of interest.References1. Dingemans, A.; Danner, U.; Parks, M. Emotion Regulation in Binge Eating Disorder: A Review. Nutrients2017, 9. [CrossRef] [PubMed]2. Trull, T.J.; Ebner-Priemer, U. Ambulatory assessment. Annu. Rev. Clin. Psychol. 2013, 9, 151–176. [CrossRef][PubMed]3. Haedt-Matt, A.A.; Keel, P.K. Revisiting the affect regulation model of binge eating: A meta-analysis ofstudies using ecological momentary assessment. Psychol. Bull. 2011, 137, 660–681. [CrossRef] [PubMed]4. Santangelo, P.; Reinhard, I.; Mussgay, L.; Steil, R.; Sawitzki, G.; Klein, C.; Trull, T.J.; Bohus, M.;Ebner-Priemer, U.W. Specificity of affective instability in patients with borderline personality disordercompared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. J. Abnorm. Psychol. 2014,123, 258–272. [CrossRef] [PubMed]5. Ebner-Priemer, U.W.; Sawitzki, G. Ambulatory Assessment of Affective Instability in Borderline PersonalityDisorder. Eur. J. Psychol. Assess. 2007, 23, 238–247. [CrossRef]© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open accessarticle distributed under the terms and conditions of the Creative Commons Attribution(CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Investigating binge eating using ecological momentary assessment: The importance of an appropriate sampling frequency

https://publikationen.bibliothek.kit.edu/1000081009/7137569

Investigating binge eating using ecological momentary assessment: The importance of an appropriate sampling frequency

Abstract

Similar works

Full text

Available Versions

Multidisciplinary Digital Publishing Institute

Directory of Open Access Journals

Crossref

KITopen