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Measuring Impulsivity in Daily Life: a Systematic Review and Recommendations for Future

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Measuring Impulsivity in Daily Life: a Systematic Review and Recommendations for Future 1 Measuring impulsivity in daily life: A systematic review and recommendations for future research Sarah A. Griffin,1 Lindsey K. Freeman,1 & Timothy J. Trull1 1Department of Psychological Sciences, University of Missouri-Columbia. Submitted for publication 2-14-2020 This paper is not the copy of record and will not exactly replicate the authoritative document published. Please do not copy or cite without the author’s permission. Authors’ Note. The National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health supported S.A.G. and L.K.F.’s contributions to this work (T32AA013526). Correspondence concerning this article should be addressed to: Sarah A. Griffin, 150 Psychology, Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO 65211. Email: [email protected] IMPULSIVITY IN DAILY LIFE 2 Abstract Impulsivity is a multi-dimensional construct that has shown utility in relation to important occupational, functional, and clinical outcomes (e.g. substance use, social functioning, aggression) in cross-sectional studies. However, trait and cross-sectional assessments of impulsivity have shown less utility in prospectively predicting specific instances of these outcomes. The recent proliferation of mobile technology has allowed for investigation into psychological phenomena in participants’ daily lives, clarifying many momentary and prospective relationships. Studying impulsivity using daily life methods offers promise in understanding impulsive processes and proximal influences on behavior. We conducted a systematic review of the literature to identify studies assessing impulsivity in daily life to characterize the conceptualization, measurement, and validity of momentary impulsivity. The studies reviewed highlight the reliability and validity of the construct of momentary impulsivity and identify areas for improvement in measurement and statistical practices. We make suggestions for future research based on the evidence presented. Key words: impulsivity, ecological momentary assessment, systematic review, psychometrics, ambulatory assessment, disinhibition, sensation seeking Public significance statement: This study reviewed and summarized published empirical studies on state impulsivity. This review found that state impulsivity can be reliably and validly measured and relates to emotional and behavioral outcomes. IMPULSIVITY IN DAILY LIFE 3 The construct of impulsivity has a long history of relevance to the fields of psychiatry and clinical psychology. Almost all models of personality and personality pathology have included a representation of impulsivity, and this construct has shown notable trans-diagnostic relevance across the lifespan. Of note, impulsive behaviors and features appear in the diagnostic criteria of approximately 20 disorders in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5; (American Psychiatric Association, 2013). Prominent examples include Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Borderline and Antisocial Personality Disorders, and Substance Use Disorders. Most investigations into impulsivity have occurred at the cross-sectional trait-level, assessing impulsivity as a personality characteristic generally stable across time and situation. To be sure, trait-level impulsivity has shown significant value in predicting important behavior and life outcomes. For example, in both clinical and non-clinical samples, impulsivity has been linked to worse outcomes in educational achievement (e.g., Spinella & Miley, 2003), social functioning (e.g., Bagge et al., 2004), occupational success (e.g., Barrick, Mount, & Judge, 2001), and physical and mental health (e.g., Bogg & Roberts, 2004). Concerning clinical outcomes, higher scores in general impulsivity have predicted drug and alcohol use (e.g., Verdejo-García, Lawrence, & Clark, 2008), bingeing and purging behaviors (e.g., Dawe & Loxton, 2004), engagement in self-injurious behaviors (e.g., Glenn & Klonsky, 2010), and aggression and violence (e.g., Miller, Zeichner, & Wilson, 2012), among other clinically-relevant behaviors. Although trait-level impulsivity has shown significant utility in predicting general patterns in these outcomes and behaviors, several fundamental issues with trait-level measures of impulsivity exist. We briefly summarize these issues here and refer readers elsewhere for a more IMPULSIVITY IN DAILY LIFE 4 complete discussion (see: Cyders & Coskunpinar, 2011; DeYoung, 2011; Dick et al., 2010). First, there is no consensus on the definition of impulsivity. A wide variety of terms and operationalizations have been used to describe impulsive tendencies including: disinhibition, inattention, risk taking, venturesomeness, and lack of deliberation, impulse control, or cognitive restraint or control. Moreover, these operationalizations and associated research tends to be siloed within fields. Second, drawing distinctions between different operationalizations of impulsivity is not simply an intellectual exercise. Impulsivity has been shown to be comprised of many meaningfully distinct constructs (e.g., Evenden, 1999; Whiteside & Lynam, 2001), and it may be better thought of as a domain. Component constructs of the domain of impulsivity have shown discrete and significant relationships with outcomes of interest. For example, traits associated with behavioral disinhibition (e.g., sensation seeking, risk taking) are associated consistently with substance use and engagement in potentially dangerous or aggressive behaviors (e.g., Berg, Latzman, Bliwise, & Lilienfeld, 2015; Griffin, Lynam, & Samuel, 2018), while the tendency to act on urges under strong negative emotion (i.e., urgency) is linked to self-injurious and suicidal behaviors, and bulimic symptoms across studies (e.g., Hamza, Willoughby, & Heffer, 2015). Third, because impulsivity and its components are defined and operationalized in so many ways, assessments of impulsive constructs vary widely and differ from each other dramatically, which may be problematic. For one, it is difficult to draw conclusions across studies because even measures of ostensibly the same constructs frequently differ in important ways and the same instrument is rarely used across studies. Additionally, recent work has shown poor convergence between self-report and behavioral task assessments intended to measure the IMPULSIVITY IN DAILY LIFE 5 same constructs (e.g., Cyders & Coskunpinar, 2011). Collectively these issues impede the comparison and integration of findings across studies. Perhaps of most importance, although impulsive traits have shown significant utility in predicting general patterns in these outcomes and behaviors, impulsive traits have shown less utility in prospectively predicting specific instances of these outcomes. In other words, impulsive traits generally can identify who will engage in specific maladaptive behaviors, but these traits are less useful in identifying when or under what circumstances those behaviors will occur. Studies using baseline trait measures of impulsivity to prospectively predict behavior typically reveal only small to moderate effects. In response to this, researchers have shown increasing interest in assessing impulsive constructs in daily life, shifting the focus from trait measures to features that may fluctuate within and across days. Conceptually, momentary impulsivity is not new. For example, researchers in the field of Attention-Deficit Hyperactivity Disorder (ADHD) have noted impulsive symptoms of the disorder fluctuate across time, even within days, (e.g., (Spencer, Biederman, & Mick, 2007; van der Meere, 2005). Research on self-control (i.e., the inverse of impulsivity) suggests that self- control seems to deplete and replenish in predictable patterns over time (e.g., (Muraven & Baumeister, 2000). Common sense and clinical intuition have also incorporated the idea that impulsivity fluctuates—no one expects an “impulsive” person to be rash and disinhibited in every moment of the day. Rather, we inherently acknowledge that impulsivity may be manifested in some moments and not in others. However, the empirical literature has only recently begun to explicitly and empirically measure impulsivity and associated features within specific moments in time. IMPULSIVITY IN DAILY LIFE 6 To date, several studies of daily life have utilized measures of impulsivity at the momentary or day-level. Impulsivity constructs were assessed repeatedly within relatively brief timeframes to allow researchers to study fluctuations over time, representing a notable break from the tradition of assessing impulsivity only as a stable trait construct. This conceptualization of momentary impulsivity has shown some validity in relation to behaviors and outcomes. For example, momentary assessments of impulsivity have shown positive associations with momentary irritability and quarrelsomeness (aan het Rot, Moskowitz, & Young, 2015), general negative affect (Tomko et al., 2015), and substance use (Trull, Wycoff, Lane, Carpenter, & Brown, 2016). Despite this preliminary evidence of predictive validity, the aforementioned measurement issues of trait-level assessments of impulsivity are also relevant to assessments of momentary impulsivity. However, to date no reviews of the literature on momentary assessments of impulsivity have been conducted. Given increased interest in studying psychological phenomena in participants’ daily lives (e.g., using ambulatory assessment (AA) methods; Trull & Ebner-
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