Identifying the Daily Trajectories of Anxiety - Book Report/Review Example

Article Summary: Daily Patterns of Anxiety in Anorexia Nervosa Affiliation Introduction In the article d DailyPatterns of Anxiety in Anorexia Nervosa: Associations with Eating Disorder Behaviors in the Natural Environment by Jason Lavender et al (2013), the authors examine the relationship between anxiety pasterns and the eating disorder behaviors in persons with Anorexia nervosa (AN). According to the authors, studies have shown that persons with AN exhibit certain eating disorder behaviors. Anxiety has been identified as one of the negative affect (NA) behaviors directly related to the study and treatment of AN. In this study, the authors’ aim was to identify the daily trajectories AN, examine the occurrence of eating disorder behaviors across the identified trajectories and study the distribution of the eating disorder behaviors across the day for the identified patterns. The authors hypothesized that eating disorder behaviors are likely to occur on those days with higher and variable anxiety (Lavender et al, 2013). In addition, the authors hypothesized that tendency of having days with high anxiety levels would be related to the presence of anxiety disorders and co-occurring mood (Lavender, et al, 2013). Methods The study participants were 118 women, 59 of whom met the DSM-IV criteria for full AN, and the other 59 met the sub threshold AN. The study sample had a mean body mass index of 17.2 kg/M2 and the mean age was 25.3 years. In the study, three measures were taken: current AN and sub threshold AN using the Structured Clinical Interview for DSM–IV Axis I Disorders, Patient Edition (SCID-I/P); personality dysfunction using the Dimensional Assessment of Personality Pathology—Basic Questionnaire (DAPP–BQ); and momentary anxiety based on the Profile of Mood states (POMS) (Lavender, et al, 2013). The study procedure first involved the recruitment of participants from three different sites in the US- Chicago, Fargo and Minneapolis. The participants were obtained from eating disorder treatment centers, advertisements in newspapers, through flier and through mailing of easing disorder professionals. Self report questionnaires and structured interviews were used to assess the participants. The participants were trained on the use of palmtop computers which they used to record the data. The collected data was reviewed by research experts. The momentary anxieties measures were collected six times a day at times at semi random times over a period of two weeks. For the statistical analyses, model identification aimed at identifying the daily trajectories of anxiety was done using the latent growth mixture modeling (LGMM) (Lavender, et al, 2013). In total, a total of 1526 participant days were subjected to analyses. In order to access the eating disorder behaviors across the trajectories, the authors used General Estimating Equations (GEE) to examine the differences in the ED behaviors across the different anxiety trajectories. The kernel density estimation was used to examine the temporal distribution of eating disorder behaviors within the identified trajectories (Lavender, et al, 2013). This procedure was used in estimating the probability that a certain behavior occurred at every hour throughout the 24 hours. Finally, in order to estimate the associations between the baseline characteristics and the trajectories, GEEs were used. Results The total EMA recording obtained form the participants were 14945, which included 9085 responses to signals, 3383 recordings of eating episodes and 999 recordings eating disorder behaviors. The study identified seven trajectories of anxiety, and these were classified as class 1-7. However, two of the frequent trajectories were characterized by stable anxiety throughout the day, and these were class 1 and class 2 trajectories labeled as ‘stable low’ and ‘stable high’ respectively. For a single participant, the number of daily trajectories ranged from 1-7. 30% of the participants exhibited one trajectory, 32% exhibited two, 19% had three and 19% exhibited four or more. The results also showed differences between trajectories for the rates of binge eating, self-induced vomiting and body checking (Lavender, et al, 2013). These differences were also found for three dietary restriction behaviors: skipping of meals, not eating for 8 wake hours and taking less than 1200cal a day (Lavender, et al, 2013). The kernel density estimations revealed separate patterns of distribution of the different eating disorder behaviors throughout the day. The results showed that some trajectories were high early mid-morning, some in the evening while others did not exhibit peaks. Discussion The study revealed that binge eating was common during the stable high and the late increasing and decreasing days. Body checking and going 8 wake hours without meals was common during late increasing anxiety days (Lavender, et al, 2013). These results support the hypothesis that eating disorder behaviors occur on those days with higher and variable anxiety. In addition, anxiety trajectories were only linked to the presence of a current mood disorder, hence failing to support the hypothesis that the presence of high anxiety was linked to the presence of anxiety disorders and co-occurring mood. The study had certain limitations. First, it is likely that the participants did not report every easting disorder behavior. Secondly, the study used stable low anxiety days as the reference point, and this neglected the likelihood of eating disorder behaviors across other trajectories. The authors state that the present findings may be useful in the future treatment of people with An. However, future research needs to be conducted to fully understand and elaborate the relationship between eating disorder behavior and anxiety. This study interested me for a number of reasons. First, the results presented in the study are important in understanding and facilitating the treatment of AN. The findings of this study will help to improve the current treatment methods used. The findings are not only helpful to Anorexia Nervosa professionals but also to those affected and their families. Secondly, in conducting their research, the authors maintained high levels of professionalism- from obtaining of the participants to the collection of data. Therefore, the study was conducted in an ethical manner. Thirdly, in conducting the research, the authors used persons with the AN disorder as their subjects. This enhances the credibility and applicability of the results obtained. Thirdly, considering that AN is not a very common disorder, the total number of studies on this disorder are limited. The contribution of these findings will be enormous. Finally, the study and analyses methods employed by the authors are current and up to date. As a recommendation, future studies should consider using both male and female subjects. Although AN is common in females than males, future studies on both sexes could help shed more light on this subject. Furthermore, in the present study, only 118 participants were involved. Future studies might consider using a higher number of participants to enhance the credibility of the results. Reference Lavender, J.M (2013). Daily Patterns of Anxiety in Anorexia Nervosa: Associations With Eating Disorder Behaviors in the Natural Environment. Journal of Abnormal Psychology, 122(3), pp. 672-683. American Psychological Association Read More