Tracking Aversive Tension among Patients with Anorexia Nervosa

Aversive tension, also called heightened emotional arousal, or tension, or psychological distress, is an unpleasant emotional state with high levels of arousal not linked to a specific emotion. This emotional state is important in dialectical behavior therapy (DBT). Patients with borderline personality disorder may use non-suicidal self-injury as a way to reduce aversive tension and to gain rapid relief from the unpleasant feelings.

Since DBT is attracting increasing attention as an eating disorder therapy, Dr. David Raphael Kolar and co-workers at Johannes Gutenberg University, Mainz, Germany, have designed an ecological momentary assessment (EMA) study to investigate aversive tension among patients with anorexia nervosa (AN). This study will be the first to evaluate aversive tension among AN patients (BMJ Open. 204. 4:e004703). The researchers will use smartphones to follow aversive tension among 20 female adolescent outpatients. Twenty healthy teens will act as controls. The young women will answer 4 short questions on their personal smartphones, and will be contacted hourly over 2 days. Such EMA studies have the advantages of collecting information in the person’s usual environment (“ecological”) and the information is collected in real time (“momentary”) rather than via retrospective recall. The authors hope to enroll 40 adolescents in the study.

Both control subjects and those with AN be monitored after first filling in a pre-study questionnaire. A free data collecting program, Epicollect™, will be used on the smartphone. FEEL-KJ, a German instrument, is used to measure emotion regulation by children and adolescents. Results of earlier studies suggest that checking with the participants hourly over only 2 days will provide enough information for analysis without the risk of losing the participant’s interest. Since a possible trigger for aversive tension in patients with AN involves meals, the researchers decided not to include an assessment of the last food intake, which itself might cause aversive tension.

The authors acknowledge that an additional challenge is the technical aspect of ambulatory monitoring, and that handling the device is may be somewhat more complicated than using a simple paper diary. However, the advantages of having real-word, in-the-moment measurements may outweigh these technical issues.