The use of ecological momentary assessment approaches in eating disorder research

Objective: Eating disorder (ED) research is increasingly focusing on the proximal antecedents to disordered eating behavior. Such antecedents may include cognitions, environmental stimuli, social interactions, and affective states. Current ED theories suggest that the relationships between antecedents and eating behavior may be complex, including interaction associations, time-lagged effects, and associations that persist only for brief periods of time. Similarly, these theories often include the consequences of behavior-influencing variables of interest (e.g., short-term reductions in negative affect). Careful examination of such theories, however, has been limited by a reliance on data collection methods not appropriate for testing these effects. Method: This study examines alternative methods for data collection and analysis that overcome previously noted limitations, using data collected in several studies with eating-disordered participants. Results: The development of a technique called ecological momentary assessment (EMA) allows the ongoing study of behavior in its natural context and reduces biases associated with retrospective recall. The development of technology that allows the sophisticated collection and storage of such data (e.g., palm-top computers), along with statistical procedures for analyzing hierarchically nested, repeated measures data, allow precise testing of complex theoretical models. Discussion: We demonstrate several important features of this research: (1) patients are willing and able to engage in EMA studies, (2) data not possible to collect using other designs are obtainable, (3) complex theoretical models can be evaluated using these data and appropriate statistical methods, and (4) the collection and analysis of EMA data present unique difficulties to ED researchers. Finally, we endorse and provide recommendations for the use of EMA in future ED research and practice.