Completed Ecological Momentary Assessment Research Articles

O1.6. AFFECTIVE DETERMINANTS OF LIFE-SPACE THROUGH GPS AND ECOLOGICAL MOMENTARY ASSESSMENT IN SCHIZOPHRENIA: WHAT GETS PEOPLE OUT OF THE HOUSE?

BackgroundPrevious research employing global positioning satellite (GPS) data and ecological momentary assessment (EMA) has shown that greater aggregated time at home and less distance traveled (diminished life-space) were associated with poorer community functioning and with more severe negative symptoms in people with schizophrenia. Emotional experiences (e.g., pleasure or anxious avoidance) may reduce time spent outside of the home. We evaluated the associations between concurrent and time-lagged positive and negative affective experiences in relation to time at home and distance travelled in the community (life-space) among people with schizophrenia compared to healthy comparators (HCs).MethodsSixty HCs (mean age = 51.2, SD = 10.9) and 91 people with schizophrenia (mean age=52, SD=9), matched on demographic characteristics, completed in-lab assessments of symptoms, cognition, and functioning. They were then given a smartphone and completed EMA assessments 7 times daily for 7 days at stratified random intervals. EMA surveys included questions about daily life activities and affect. GPS coordinates were collected every 5 minutes, 24 hours a day, over the 7-day study period.ResultsParticipants with schizophrenia spent more time at home than HCs (t = -4.95, p < 0.001). Sadness and ratings of relaxation were not associated with distance traveled away or time spent at home. For HCs, happiness was associated with more distance traveled away as measured by GPS (B=6.85, SE= 3.04, Wald Chi-Square = 5.067, p=0.024). However, for people with schizophrenia, only greater nervousness ratings were associated with more distance from home (B=3.41, SE=1.30, Wald Chi-Square=6.88, p=0.009). Moreover, for people with schizophrenia, greater nervousness ratings were associated with more time spent at home (B=2.07, SE= 0.98, Wald Chi-Square=4.43, p=0.035), and greater nervousness also predicted that a person with schizophrenia would be at home at the next survey in lead analyses, (F(1, 3029)=7.533, p=0.006). Taken together, these results suggest both greater nervousness associated with greater distance away from home and anxious avoidance of leaving the home.DiscussionFor individuals with schizophrenia, greater overall anxiety was associated with reduced time spent out of the home, and when patients did leave the home, greater distance travelled was associated with greater nervousness. In contrast, HC participants experienced greater positive emotion with larger life-space. These data suggest a significant momentary temporal association of anxiety and behavior in schizophrenia, such that greater nervousness predicted an individual would be more likely to stay at home. These findings suggest avoidance of negative emotion may also contribute to diminished motivated behavior, which may even act as an emotion regulation strategy. Life-space, which can be measured readily over time by mobile devices, may be a novel target for rehabilitative interventions for anxious avoidance in schizophrenia.

The Influence of Leisure Engagement on Daily Emotional Well-Being

Leisure engagement is believed to offer emotional benefits. However, relatively few studies have examined how leisure engagement influences emotional well-being in the context of individuals’ everyday lives. The current study examined the associations between leisure engagement and daily emotional well-being, as measured by participants’ mean levels of positive affect (PA), PA variability, and PA reactivity to stressors. Using smartphones, participants (n = 176) completed ecological momentary assessments (EMAs) 5 times per day for 14 consecutive days. The Pearson correlations indicated that the participants who engaged in leisure more frequently experienced higher mean levels of PA and lower PA variability in daily life compared to those with less frequent leisure engagement. However, multilevel models indicated that individuals’ differences in frequency of leisure engagement did not influence their emotional reactivity in response to daily stressors. The findings extend the importance of leisure engagement to consider the dynamics of daily emotional well-being.

Methods and design for the ADAPT study: Application of integrateD Approaches to understanding Physical activity during the Transition to emerging adulthood

BackgroundThe overarching objective of the study is to obtain a comprehensive understanding of the salient factors predicting changes in physical activity (PA) during adolescents’ transition into emerging adulthood. Using the Multi-Process Action Control model as our guiding framework, we will examine how implicit and explicit psychological processes along with regulatory practices impact PA change during this major life transition. Additionally, we will use a real-time data capture method called Ecological Momentary Assessment to further investigate how environmental and contextual factors, and momentary psychosocial influences effect PA patterns across this dynamic life stage.MethodsThe ADAPT study is a 4-year project comprised of two interrelated studies. Study I is a large prospective cohort study that will invite all grade 11 students across one large school board (a total of seven secondary schools) to participate by completing an online questionnaire. Using a cluster randomization approach, a subset of students from each school will be invited to participate in Study II, whereby participants will wear an accelerometer and complete Ecological Momentary Assessments 5 times a day over a 7-day study period. For both studies, following baseline assessments, there will be three annual follow-up assessments approximately 12 months apart.DiscussionThe current study represents one of the largest longitudinal cohort studies examining PA and its determinants and associated consequences among adolescents transitioning out of high school into emerging adulthood. Findings from this study will provide a much more in-depth understanding of how and why changes in PA behaviour occur across this first major life transition.

A Mobile Just-in-Time Adaptive Intervention for Smoking Cessation: Pilot Randomized Controlled Trial.

BackgroundSmartphone apps for smoking cessation could offer easily accessible, highly tailored, intensive interventions at a fraction of the cost of traditional counseling. Although there are hundreds of publicly available smoking cessation apps, few have been empirically evaluated using a randomized controlled trial (RCT) design. The Smart-Treatment (Smart-T2) app is a just-in-time adaptive intervention that uses ecological momentary assessments (EMAs) to assess the risk for imminent smoking lapse and tailors treatment messages based on the risk of lapse and reported symptoms.ObjectiveThis 3-armed pilot RCT aimed to determine the feasibility and preliminary efficacy of an automated smartphone-based smoking cessation intervention (Smart-T2) relative to standard in-person smoking cessation clinic care and the National Cancer Institute’s free smoking cessation app, QuitGuide.MethodsAdult smokers who attended a clinic-based tobacco cessation program were randomized into groups and followed for 13 weeks (1 week prequitting through 12 weeks postquitting). All study participants received nicotine patches and gum and were asked to complete EMAs five times a day on study-provided smartphones for 5 weeks. Participants in the Smart-T2 group received tailored treatment messages after the completion of each EMA. Both Smart-T2 and QuitGuide apps offer on-demand smoking cessation treatment.ResultsOf 81 participants, 41 (50%) were women and 55 (68%) were white. On average, participants were aged 49.6 years and smoked 22.4 cigarettes per day at baseline. A total of 17% (14/81) of participants were biochemically confirmed 7-day point prevalence abstinent at 12 weeks postquitting (Smart-T2: 6/27, 22%, QuitGuide: 4/27, 15%, and usual care: 4/27, 15%), with no significant differences across groups (P>.05). Participants in the Smart-T2 group rated the app positively, with most participants agreeing that they can rely on the app to help them quit smoking, and endorsed the belief that the app would help them stay quit, and these responses were not significantly different from the ratings given by participants in the usual care group.ConclusionsDynamic smartphone apps that tailor intervention content in real time may increase user engagement and exposure to treatment-related materials. The results of this pilot RCT suggest that smartphone-based smoking cessation treatments may be capable of providing similar outcomes to traditional, in-person counseling.Trial RegistrationClinicalTrials.gov NCT02930200; https://clinicaltrials.gov/show/NCT02930200

Real-Time Mobile Monitoring of Drinking Episodes in Young Adult Heavy Drinkers: Development and Comparative Survey Study.

BackgroundBinge drinking, defined as consuming five or more standard alcoholic drinks for men (four for women) within a 2-hour period, is common among young adults and is associated with significant alcohol-related morbidity and mortality. To date, most research on this problem in young adults has relied upon retrospective questionnaires or costly laboratory-based procedures. Smartphone-based ecological momentary assessment (EMA) may address these limitations by allowing researchers to measure alcohol use and related consequences in real time and in drinkers’ natural environments. To date, however, relatively less research has systematically examined the utility of this approach in a sample of young adults targeting real-world heavy drinking episodes specifically.ObjectiveThis study aimed to evaluate the feasibility, acceptability, and safety of a smartphone-based EMA method targeting binge drinking and related outcomes in heavy drinking young adults during real-world drinking occasions.MethodsYoung adult binge drinkers in the smartphone group (N=83; mean 25.4 (SD 2.6) years; 58% (48/83) male; bingeing on 23.2% (6.5/28) days in the past month) completed baseline measures of alcohol use and drinking-related consequences, followed by up to two smartphone-based EMA sessions of typical drinking behavior and related outcomes in their natural environments. They also completed next-day and two-week follow-up surveys further assessing alcohol use and related consequences during the EMA sessions and two weeks after study participation, respectively. A separate demographic- and drinking-matched safety comparison group (N=25) completed the baseline and two-week follow-up surveys but did not complete EMA of real-world drinking behavior.ResultsMost participants (71%, 59/83) in the smartphone group engaged in binge drinking during at least one 3-hour EMA session, consuming 7.3 (SD 3.0) standard alcoholic drinks. They completed 87.2% (507/581) system-initiated EMA prompts during the real-world drinking episode, supporting the feasibility of this approach. The procedure was acceptable, as evidenced by high participant ratings for overall satisfaction with the EMA software and study procedures and low ratings for intrusiveness of the mobile surveys. Regarding safety, participants endorsed few drinking-related consequences during or after the real-world drinking episode, with no adverse or serious adverse events reported. There were no differences between the groups in terms of changes in drinking behavior or consequences from baseline to two-week follow-up.ConclusionsThis study provided preliminary support for the feasibility, acceptability, and safety of a smartphone-based EMA of real-time alcohol use and related outcomes in young adult heavy drinkers. The results suggest that young adults can use smartphones to safely monitor drinking even during very heavy drinking episodes. Smartphone-based EMA has strong potential to inform future research on the epidemiology of and intervention for alcohol use disorder by providing researchers with an efficient and inexpensive way to capture large amounts of data on real-world drinking behavior and consequences.

Interpersonal Tensions and Pain Among Older Adults: The Mediating Role of Negative Mood.

To examine whether (a) negative social encounters and physical pain are linked throughout the day, (b) negative mood mediates these associations, and (c) these associations vary by closeness with social partners. Adults aged 65+ (n = 313) completed ecological momentary assessments and reported their negative social encounters, physical pain, and mood every 3 hr throughout the day for 5-6 days. Multilevel models revealed that negative social encounters were associated with greater pain at each 3-hr interval and that this association was mediated by negative mood during the same interval. Negative encounters with less close partners were associated with pain, but negative encounters with close partners were not. Regulating older adults' negative emotions may be crucial to improving their daily pain. Further, interventions focusing on negative encounters with less close partners in daily life may help mitigate older adults' experiences of pain throughout the day.

MATTERS OF THE HEART: DAILY SOCIAL INTERACTIONS AND CARDIOVASCULAR REACTIVITY IN MIDDLE AND OLD AGE

Social ties are essential for survival but the mechanisms accounting for this link are unclear. This study examined links between daily interpersonal experiences and cardiovascular reactivity. A total of 34 participants (aged 40 to 80) completed ecological momentary assessment surveys every three hours for 4 days and wore a device that assessed heart rate (HR) and heart rate variability (HRV). Multilevel models revealed that a greater number of social interactions and negative social interactions predicted increased HR. Links between social interactions and cardiovascular reactivity varied by gender and race. A greater number of interactions and negative interactions predicted increased HRV among men and not women. A greater number of social interactions predicted increased HR among Black individuals and White women but not White men. Thus, social interactions appear to get under the skin via the cardiovascular system but in unique ways that vary by gender and race.

Depressive Symptoms Amplify Emotional Reactivity to Daily Perceptions of Peer Rejection in Adolescence

During adolescence, interpersonal stressors such as peer rejection pose challenges to emotion regulation. Yet, very little is known about how these transactional processes unfold in adolescents' daily lives. This study investigated adolescents' (a) emotional reactivity to daily perceptions of peer rejection, which concerns concurrent changes in negative and positive emotions, and (b) emotional recovery from daily perceptions of peer rejection, which concerns subsequent changes in negative and positive emotions. Because depressive symptoms can compromise effectiveness of emotion regulation, it was investigated as a moderator for emotional reactivity and recovery to daily perceptions of peer rejection. The sample consisted of 303 adolescents (59% girls; Mage = 14.20, SD = 0.54; range 13-16 years) who reported depressive symptoms at baseline and completed ecological momentary assessments of emotions and perceived peer rejection at nine random time-points per day for six consecutive days. Results from multi-level modeling analyses showed that perceived peer rejection was related to emotional reactivity (i.e., higher levels of negative emotions and lower levels of positive emotions). This effect was stronger for those with higher depressive symptoms. For emotional recovery, perceived peer rejection had lasting effects on adolescents' negative emotions, but was not related to positive emotions. Depressive symptoms did not moderate effects of perceived peer rejection on emotional recovery. This study provides a more nuanced understanding of how depressive symptoms amplify the emotional impact of perceived peer rejection in adolescents' day-to-day lives.

Bidirectional Associations of Momentary Affect with Physical Activity and Sedentary Behaviors in Working Adults.

Affective experiences and movement-based behaviors form a system that has been shown to influence exercise adherence and mental health outcomes. Little is known about the naturalistic dynamics of the reciprocal associations in this system. We examined the time intervals at which momentary affect precedes and follows movement-based behaviors in everyday life. A community sample of working adults (n = 111) completed ecological momentary assessments (EMA) asking about current affect states (sad, happy, tired, and interested) six times a day for three consecutive days. Ratings were used to generate scores for momentary affective arousal and valence. Participants also wore an activity monitor. Total activity counts and sedentary duration in the shorter to longer time intervals (5-120 min) before or after EMA were used as indicators of movement-based behaviors. Multilevel modeling showed that current affective arousal predicted higher subsequent activity counts in the longer time intervals (120 min) and less subsequent sedentary behavior in the shorter to longer time intervals (5, 60, and 120 min). For the reversed sequence, neither movement-based behavior predicted subsequent momentary arousal or valence. Affective valence was unrelated to movement-based behaviors in either temporal direction. Some naturally occurring affective experiences (i.e., arousal) might precede, rather than follow, movement-based behaviors. Understanding affective arousal may contribute to improved management of subsequent movement-based behaviors in everyday life.

Cognitive performance of breast cancer survivors in daily life: Role of fatigue and depressed mood.

Cancer and its treatment are associated with long-term cognitive deficits. However, most studies of cancer patients have used traditional, office-based cognitive evaluations instead of assessing patients in their daily lives. Recent research in cognitive aging suggests that variability in performance may be a sensitive indicator of cognitive decline. Using ecological momentary assessment (EMA), we examined cognitive variability among breast cancer survivors and evaluated whether ratings of fatigue and depressed mood were associated with cognition. Participants were 47 women (M age = 53.3 years) who completed treatment for early stage breast cancer 6 to 36 months previously. Smartphones were preloaded with cognitive tests measuring processing speed, executive functioning, and memory, as well as rating scales for fatigue and depressed mood. Participants were prompted five times per day over a 14-day period to complete EMA cognitive tasks and fatigue and depressed mood ratings. Cognitive variability was observed across all three EMA cognitive tasks. Processing speed responses were slower at times that women rated themselves as more fatigued than their average (P < .001). Ratings of depressed mood were not associated with cognition. This study is the first to report cognitive variability in the daily lives of women treated for breast cancer. Performance was worse on a measure of processing speed at times when a woman rated her fatigue as greater than her own average. The ability to identify moments when cognition is most vulnerable may allow for personalized interventions to be applied at times when they are most needed.

(117) Characterizing Fibrofog in Daily Life: Ambulatory Cognitive Functioning in Adults with Fibromyalgia and Matched Controls

Most people with fibromyalgia (FM) report “fibrofog”, or cognitive dysfunction. To better characterize fibrofog in daily life, we conducted an ambulatory study of subjective and objective cognitive function in real-world settings in persons with FM and sex-, age-, and education-matched healthy controls (HC) to test whether: 1) people with FM demonstrate poorer cognitive function on ambulatory measures; 2) people with FM demonstrate a different diurnal pattern of cognitive function; and 3) subjective cognitive function corresponds more highly with objective cognitive measures in HC compared to FM. Participants (N=102; nFM=50; nHC=52) completed ecological momentary assessments of perceived cognitive function (perceived clarity and speed) on a numerical rating scale of 0-100 and cognitive tests of processing speed (Symbol Search) and working memory (Dot Matrix) via a smartphone app at 5 quasi-random times/day for 8 days. The FM group scored significantly lower than HC on measures of self-reported cognitive functioning, as well as on objective measures of processing speed and working memory. Results from multilevel models showed that both groups demonstrated similar diurnal patterns for objective measures of working memory, which was stable across the day, and objective processing speed, which was slowest at wake- and bed-times and fastest midday. For both groups, perceived cognitive dysfunction was highest upon waking and improved across the day; however, the HC group showed a significantly steeper rate of improvement. Perceived cognitive dysfunction corresponded only with processing speed, not working memory, and there were no group differences in these associations. Findings for ambulatory subjective and objective cognitive function in FM are generally consistent with findings from lab-based studies; the FM group demonstrated relatively worse cognitive functioning, but diurnal patterns and associations between objective/subjective functioning were similar to HC.

(119) The Role of Environmental Distractions in the Experience of Fibrofog in Real-World Settings

Cognitive problems in fibromyalgia (FM), or “fibrofog,” are highly prevalent but not well-characterized. Research shows that deficits in cognitive performance in FM only emerge in the context of a stimulating testing environment, suggesting a potentially important role for distraction in the experience of both subjective (perceived) and objective (performed) fibrofog. Unexplored to date is the role of real-world distractions in fibrofog in everyday life. To address limitations in our understanding of fibrofog in daily life, we conducted a study of ambulatory subjective and objective cognitive function in a sample of adults with FM and age-, sex-, and education-matched healthy controls (HC) to test the hypotheses that: 1) people with FM report environmental distractions at a higher rate than HCs; and 2) relative to HCs, people with FM show steeper declines in subjective and objective cognitive functioning in the context of real-world distraction. Fifty adults with FM and 52 controls (N=102) completed ecological momentary assessments of perceived cognitive dysfunction on a numerical rating scale of 0-100 and cognitive tests of processing speed (Symbol Search) and working memory (Dot Matrix) via a smartphone app, 5X/day for 8 consecutive days. After each cognitive testing session, participants were asked whether they were distracted by anything in the environment during testing. Consistent with expectations, the FM group reported distractions during ambulatory tests at a higher rate (41.1% of tests) compared to the HCs (30.0% of tests; χ2=45.20, p

Exploring the Use of Smartphone Geofencing to Study Characteristics of Alcohol Drinking Locations in High-Risk Gay and Bisexual Men.

Geofencing offers new opportunities to study how specific environments affect alcohol use and related behavior. In this study, we examined the feasibility of using geofencing to examine social/environmental factors related to alcohol use and sexual perceptions in a sample of gay and bisexual men (GBM) who engage in heavy drinking and high-risk sex. HIV-negative GBM (N=76) completed ecological momentary assessments for 30days via a smartphone application and were prompted to complete surveys when inside general geofences set around popular bars and clubs. A subset (N=45) were also asked to complete surveys when inside personal geofences, which participants set themselves by identifying locations where they typically drank heavily. Approximately 49% of participants received a survey prompted by a general geofence. Among those who identified at least 1 personal drinking location, 62.2% received a personal geofence-prompted survey. Of the 175 total location-based surveys, 40.2% occurred when participants were not at the location that was intended to be captured. Participants reported being most able to openly express themselves at gay bars/clubs and private residences, but these locations were also more "sexualized" than general bars/clubs. Participants did not drink more heavily at gay bars/clubs, but did when in locations with more intoxicated patrons or guests. Geofencing has the potential to improve the validity of studies exploring environmental influences on drinking. However, the high number of "false-positive" prompts we observed suggests that geofences should be used carefully until improvements in precision are more widely available.

Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High-Risk Youth with Asthma: Pilot Study

BackgroundYouth with asthma who have poor medication adherence, have limited access to care, and are frequently seen in the acute care setting are often termed “high risk.”ObjectiveThis study aimed to design and test the feasibility of using smartphone technology to assess contextual factors that may impact changes in daily medication adherence and to identify new symptom episodes among high-risk youth with asthma in their home environment.MethodsYouth aged 8-17 years with high-risk asthma from 2 children’s hospitals were eligible for the 2-month study. An app was downloaded on participants’ phones at enrollment. Daily text message (short message service) reminders were sent to complete ecological momentary assessment of asthma symptoms and other contextual factors such as emotional state using the app. Bluetooth inhaler devices were used to record timestamps of inhaler use with the ability to review and manually enter data. The acceptability was assessed with surveys, key informant interviews (KII), and frequency of days with asthma data. KII data were used in an iterative design approach to identify challenges, strengths, and suggestions for maximizing use. Generalized linear mixed modeling was used to preliminarily explore contextual factors associated with changes in daily adherence.ResultsWe enrolled 14 children aged 8-16 years (13/14, 93% were African Americans). Over the 2-month study period, participants reported coughing (42/110, 38%), wheezing (8/111, 7%), chest tightness (9/109, 8%), boredom (57/109, 52%), and 10 new asthma symptom episodes. The controller medication adherence was 30%, which increased significantly on days with asthma symptoms or boredom. Data were received on 89% (606/681) of study days. Surveys and KIIs suggest acceptability among youth and their caregivers. Challenges reported during the study included lost or damaged phones and available memory.ConclusionsYouth and their caregivers reported the acceptability of using smartphones for real-time asthma monitoring. Overall, the controller medication adherence was low but increased significantly on days with reported asthma symptoms or boredom, suggesting that daily contextual factors may be associated with a change in the adherence behavior.

Intra-individual study of mindfulness: ecological momentary perspective in post-surgical lung cancer patients.

The period of recovery following a lung-cancer surgery presents unique challenges and psychological demands. The study utilized ecological momentary assessments (EMA) to repeatedly sample mindfulness states in a sample of mindfulness-untrained individuals following hospital discharge. Intra- and inter- individual variability was assessed to examine cancer patients' natural capacity to exhibit mindfulness states during two weeks of recovery. Fifty nine stage I lung cancer patients (61% women, mean age = 66.1, SD = 7.9) completed EMA twice a day for two weeks. Mean level of mindfulness in the sample was low and equaled .49 (SD = .51) on the 5 point scale, with older participants being less likely to endorse mindful states. Net variability in mindfulness, defined as the person-based standard deviation in momentary scores, equaled .42 (SD = .26), ranging for 0 to 1.3 and indicating very modest variability for most participants. Results of the multi-level variance partitioning model revealed 41.4% of variance in mindfulness scores at the inter-individual, 2.4% on the temporal (i.e., .2% weekly and 2.2% daily), and 56.2% on the momentary levels. Findings indicate that, for cancer patients recovering from surgery, the innate ability to exhibit mindfulness is limited. From the methodological standpoint, consideration of intra-individual variability has implications for conceptualization and design of EMA studies.

Reprint of Using ecological momentary assessments to predict relapse after adult substance use treatment

BackgroundA key component of relapse prevention is to self-monitor the internal (feelings or cravings) and external (people, places, activities) factors associated with relapse. Smartphones can deliver ecological momentary assessments (EMA) to help individuals self-monitor. The purpose of this exploratory study was to develop a model for predicting an individual's risk of future substance use after each EMA and validate it using a multi-level model controlling for repeated measures on persons. MethodsData are from 21,897 observations from 43 adults following their initial episode of substance use treatment in Chicago from 2015 to 2016. Participants were provided smartphones for six months and asked to complete two to three minute EMAs at five random times per day (81% completion). In any given EMA, 2.7% reported substance use and 8% reported any use in the next five completed EMA. Chi-square Automatic Interaction Detector (CHAID) was used to classify EMAs into six levels of risk and then validated with a hierarchical linear model (HLM). ResultsThe major predictors of substance use in the next five completed EMAs were substance use pattern over the current and prior five EMAs (no recent/current use, either recent or current use [but not both], continued use [both recent and current]), negative affect (feelings), and craving (rating). Negative affect was important for EMAs with no current or recent use reported; craving was important for EMAs with either recent or current use; and neither mattered for EMAs with continued use. The CHAID gradated EMA risk from 0.7% to 36.6% of the next five completed EMAs with substance use reported. It also gradated risk of “any” use in the next five completed EMAs from 3% to 82%. ConclusionsThis study demonstrated the potential of using smartphone-based EMAs to monitor and provide feedback for relapse prevention in future studies.

Are individuals with loss-of-control eating more prone to dietary lapse in behavioural weight loss treatment? An ecological momentary assessment study.

Individuals with overweight/obesity and loss-of-control eating (LOC) may experience poorer outcomes from behavioural weight loss due to reactivity to internal (e.g., affective and physical) states that impact treatment adherence (e.g., dietary lapses). This study examined (a) whether the presence of LOC increased risk for dietary lapses and (b) the moderating role of LOC on the relation between internal states and dietary lapses. Individuals (n=189) with overweight and obesity completed ecological momentary assessment early in behavioural weight loss. LOC was positively associated with dietary lapse. LOC did not moderate the relation between momentary changes in internal states and dietary lapses. However, the effect of average levels of internal states on lapses was attenuated for those with LOC. Results suggest that those with LOC are at higher risk of dietary lapse, whereas elevated average levels of internal states may contribute to early inadherence for those without LOC.

Using ecological momentary assessments to predict relapse after adult substance use treatment

BackgroundA key component of relapse prevention is to self-monitor the internal (feelings or cravings) and external (people, places, activities) factors associated with relapse. Smartphones can deliver ecological momentary assessments (EMA) to help individuals self-monitor. The purpose of this exploratory study was to develop a model for predicting an individual's risk of future substance use after each EMA and validate it using a multi-level model controlling for repeated measures on persons. MethodsData are from 21,897 observations from 43 adults following their initial episode of substance use treatment in Chicago from 2015 to 2016. Participants were provided smartphones for six months and asked to complete two to three minute EMAs at five random times per day (81% completion). In any given EMA, 2.7% reported substance use and 8% reported any use in the next five completed EMA. Chi-square Automatic Interaction Detector (CHAID) was used to classify EMAs into six levels of risk and then validated with a hierarchical linear model (HLM). ResultsThe major predictors of substance use in the next five completed EMAs were substance use pattern over the current and prior five EMAs (no recent/current use, either recent or current use [but not both], continued use [both recent and current]), negative affect (feelings), and craving (rating). Negative affect was important for EMAs with no current or recent use reported; craving was important for EMAs with either recent or current use; and neither mattered for EMAs with continued use. The CHAID gradated EMA risk from 0.7% to 36.6% of the next five completed EMAs with substance use reported. It also gradated risk of “any” use in the next five completed EMAs from 3% to 82%. ConclusionsThis study demonstrated the potential of using smartphone-based EMAs to monitor and provide feedback for relapse prevention in future studies.

Ecological momentary assessment of self-attitudes in response to dietary lapses.

To examine whether self-attitudes and self-efficacy after dietary lapses relate to lapse frequency or predict risk for lapsing again on the same day. Adults with overweight/obesity (n = 91) completed ecological momentary assessment for 14 days at the start of a lifestyle modification program. At each survey, participants reported whether they had experienced a dietary lapse, and, if so, reported their self-attitudes (i.e., self-criticism, self-forgiveness, self-regard) and self-efficacy. The relationships between participants' typical (i.e., average level for each participant across lapses) self-attitudes/self-efficacy after lapsing and lapse frequency were examined using correlations. Generalized estimating equations examined whether participants' typical (average across lapses; between-person effect) self-attitudes/self-efficacy or momentary (i.e., level of each variable at a particular lapse relative to one's typical level; within-person effect) self-attitudes/self-efficacy predicted same-day lapse occurrence. Lower typical self-efficacy and more negative typical self-regard related to greater lapse frequency. Additionally, lower momentary self-criticism predicted greater likelihood of same-day lapse occurrence. There also was a quadratic relationship between typical self-regard and risk of same-day lapse occurrence, such that individuals with either more negative or more positive typical self-regard were more likely to lapse on the same day. Findings provide preliminary support for the relevance of self-attitudes and self-efficacy to lapses during early lifestyle modification. While greater typical self-efficacy and more positive typical self-regard are associated with fewer lapses, lower momentary self-criticism and very positive or negative typical self-regard may confer risk for same-day lapses. (PsycINFO Database Record

Rationale, design and pilot feasibility results of a smartphone-assisted, mindfulness-based intervention for smokers with mood disorders: Project mSMART MIND

BackgroundAlthough individuals with psychiatric disorders are disproportionately affected by cigarette smoking, few outpatient mental health treatment facilities offer smoking cessation services. In this paper, we describe the development of a smartphone-assisted mindfulness smoking cessation intervention with contingency management (SMI-CM), as well as the design and methods of an ongoing pilot randomized controlled trial (RCT) targeting smokers receiving outpatient psychiatric treatment. We also report the results of an open-label pilot feasibility study. MethodsIn phase 1, we developed and pilot-tested SMI-CM, which includes a smartphone intervention app that prompts participants to practice mindfulness, complete ecological momentary assessment (EMA) reports 5 times per day, and submit carbon monoxide (CO) videos twice per day. Participants earned incentives if submitted videos showed CO≤6ppm. In phase 2, smokers receiving outpatient treatment for mood disorders are randomized to receive SMI-CM or enhanced standard treatment plus non-contingent CM (EST). ResultsThe results from the pilot feasibility study (N=8) showed that participants practiced mindfulness an average of 3.4times/day (≥3min), completed 72.3% of prompted EMA reports, and submitted 68.0% of requested CO videos. Participants reported that the program was helpful overall (M=4.85/5) and that daily mindfulness practice was helpful for both managing mood and quitting smoking (Ms=4.50/5). ConclusionsThe results from the feasibility study indicated high levels of acceptability and satisfaction with SMI-CM. The ongoing RCT will allow evaluation of the efficacy and mechanisms of action underlying SMI-CM for improving cessation rates among smokers with mood disorders.