{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:02:08Z","timestamp":1789621328385,"version":"build-2803163510"},"reference-count":39,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,4,1]]},"published-print":{"date-parts":[[2014,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Monitoring and reduction of aversive tension is a core issue in dialectical behaviour therapy of patients. It has been shown that aversive tension is increased in adult borderline personality disorder and is linked to low emotion labelling ability. However, until now there is no documented evidence that patients with anorexia nervosa suffer from aversive tension as well. Furthermore the usability of a smartphone application for ambulatory monitoring purposes has not been sufficiently explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We compare the mean and maximum self-reported aversive tension in 20 female adolescents (12\u201319\u2005years) with anorexia nervosa in outpatient treatment with 20 healthy controls. They are required to answer hourly, over a 2-day period, that is, about 30 times, four short questions on their smartphone, which ensures prompt documentation without any recall bias. At the close out, the participants give a structured usability feedback on the application and the procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The achieved result of this trial has direct relevance for efficient therapy strategies and is a prerequisite for trials regarding dialectical behaviour therapy in anorexia nervosa. The results will be disseminated through peer-review publications. The ethics committee of the regional medical association in Mainz, Germany approved the study protocol under the reference number 837.177.13.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration number<\/jats:title>\n                    <jats:p>The trial is registered at the German clinical trials registration under the reference number DRKS00005228.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2013-004703","type":"journal-article","created":{"date-parts":[[2014,4,24]],"date-time":"2014-04-24T03:24:04Z","timestamp":1398309844000},"page":"e004703","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Aversive tension of adolescents with anorexia nervosa in daily course: a case-controlled and smartphone-based ambulatory monitoring trial"],"prefix":"10.1136","volume":"4","author":[{"given":"David Raphael","family":"Kolar","sequence":"first","affiliation":[{"name":"Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"B\u00fcrger","sequence":"additional","affiliation":[{"name":"Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Hammerle","sequence":"additional","affiliation":[{"name":"Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkehart","family":"Jenetzky","sequence":"additional","affiliation":[{"name":"Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg-University Mainz, Mainz, Germany"},{"name":"Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,4,23]]},"reference":[{"key":"2025121513441710000_4.4.e004703.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)05363-5"},{"key":"2025121513441710000_4.4.e004703.2","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20369"},{"key":"2025121513441710000_4.4.e004703.3","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/S0140-6736(13)61746-8","article-title":"Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial","volume":"383","author":"Zipfel","year":"2014","journal-title":"Lancet"},{"key":"2025121513441710000_4.4.e004703.4","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1186\/1745-6215-14-160","article-title":"The MOSAIC study\u2014comparison of the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) with Specialist Supportive Clinical Management (SSCM) in outpatients with anorexia nervosa or eating disorder not otherwise specified, anorexia nervosa type: study protocol for a randomized controlled trial","volume":"14","author":"Schmidt","year":"2013","journal-title":"Trials"},{"key":"2025121513441710000_4.4.e004703.5","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-0030-1265972","article-title":"Dialektisch-behaviorale Therapie f\u00fcr Essst\u00f6rungen (DBT-E)","volume":"61","author":"Sipos","year":"2011","journal-title":"Psychother Psychosom Med Psychol"},{"key":"2025121513441710000_4.4.e004703.6","unstructured":"Linehan MM . 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