Completed Ecological Momentary Assessment Research Articles

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.

Craving and acute effects of alcohol in youths' daily lives: Associations with alcohol use disorder severity.

Identifying factors associated with the progression from recreational to pathological drinking in youth holds high clinical and theoretical importance. The present study tested cross-sectional associations of alcohol use disorder (AUD) severity with putative mechanisms of AUD progression among youth ages 15-24 years, namely acute subjective effects of alcohol and craving. Male (n = 44) and female (n = 42) youth completed ecological momentary assessments when not drinking, just before drinking, and while drinking in the natural environment via handheld wireless devices. Youth were recruited from the community and were frequent and heavy drinkers, the majority (93%) with at least 1 AUD symptom (M = 3.4, SD = 2.4). Findings from youths' daily lives suggested that how youth feel while they drink depends, in part, on their severity of AUD pathology. In support of hypotheses, youths with more progressed drinking pathology (i.e., those with more symptoms of AUD) reported greater reductions in craving and tension while drinking, relative to nondrinking times. In partial support of hypotheses, males with greater AUD symptomatology reported marginally attenuated increases in stimulatory states while drinking; however, contrary to hypotheses, females with greater AUD symptomatology reported enhanced increases in stimulation while drinking. This research leveraged ecological momentary assessment methods to study subjective responses to alcohol and craving in youths' daily lives and to cross-sectionally test putative associations with AUD etiology. This work adds to literature supporting subjective responses to alcohol in the pathogenesis of alcoholism, specifically by highlighting their importance during the period in life when alcohol problems typically first emerge. (PsycINFO Database Record

Momentary Associations Between Reported Craving and Valuing Health in Daily Smokers.

Research suggests that a blunted response to nondrug rewards, especially under conditions associated with strong cigarette cravings, is associated with reduced abstinence motivation in daily smokers. One limitation of previous studies is that they have largely focused on monetary rewards as broad representative of nondrug rewards. It remains unclear whether craving dampens responses to more abstract nondrug rewards, such as personal values. Personal values often have a positive valence and are frequently assumed to remain stable across time and situations. However, there may be time-varying and contextual influences on smokers' appraisal of values in daily life. Characterizing fluctuations in value importance in relation to relapse precipitants (eg, craving) may inform interventions that leverage personal values as motivation for cessation. Daily smokers (n = 18) completed ecological momentary assessment surveys measuring the importance of specific personal values and smoking-related variables during 8 days of monetarily reinforced cigarette abstinence. We hypothesized that value ratings would demonstrate adequate within-person heterogeneity for multilevel modeling and that within-person fluctuations in craving would be negatively related to valuing personal health. All values demonstrated adequate within-person variability for multilevel modeling. Within-person craving was negatively related to health valuation (p = .012) and a cross-level interaction (p > .0001) suggested this effect is stronger for individuals who report greater overall craving. Greater craving is associated with decreased importance of personal health in the moment, particularly for those with high average levels of craving. Timely interventions that bolster importance of health during moments of elevated craving can potentially improve cessation outcomes. This study builds on research highlighting the positive influence of personal values in motivating behavior change. Values are an often used, but poorly studied, construct that has considerable utility in smoking cessation. Valuing personal health is frequently reported as a primary motivator for a quit attempt. Inasmuch as personal health is a distal nondrug reward used to motivate smoking abstinence, naturalistic evaluation of health importance, and motivators for continued smoking (ie, craving) could inform the timing and content of smoking treatment. This study is among the first to evaluate momentary assessment of personal values and craving within daily life.

Ecological Momentary Assessment of Dietary Lapses Across Behavioral Weight Loss Treatment: Characteristics, Predictors, and Relationships with Weight Change.

Adherence to dietary prescriptions is critical for successful weight loss and weight loss maintenance. However, research on specific instances of inadherence (lapses) is limited, and findings regarding the frequency, nature, and causes of lapses are mixed. Additionally, no studies have examined lapses over the course of a weight loss program. In the context of a reduced calorie diet prescribed as part of a behavioral treatment, we aimed to characterize lapse occurrence, examine lapse frequency across treatment, examine predictors of lapses, and assess the relationship between lapses and weight loss. Adults (n=189) enrolled in a 12-month behavioral weight loss program completed ecological momentary assessment (EMA) at baseline, mid-treatment, and end of treatment. At each EMA survey, participants indicated whether a lapse had occurred, and responded to questions assessing situational, environmental, and affective states. Lapse frequency showed a curvilinear relationship over time, such that frequency first decreased and then increased. Lapse frequency at baseline was negatively associated with early and overall weight loss. Lapses most often occurred at home, in the evenings, on the weekends, and entailed eating a forbidden food. Greater overall levels of assessed affective and environmental triggers predicted lapses, and greater momentary hunger and deprivation, and the presence of palatable food, also prospectively predicted lapses. In addition to characterizing lapse frequency, the current study identified prospective predictors of lapses across treatment. These findings support the importance of lapses to weight control and provide insight for potential targets of intervention to prevent lapse occurrence.

Ecological Momentary Assessment (EMA) Goes to Jail

Abstract. Ecological Momentary Assessment (EMA) involves the repeated collection of data in everyday life. This method has helped uncover underlying mechanisms in several mental disorders. EMA studies are still scarce in adolescent patients and particularly incarcerated juvenile offenders (IJO), possibly due to their frequent rule-breaking and high impulsivity. This study evaluated the feasibility and reliability of EMA in IJO. One hundred three antisocial adolescents (mean age 14.8, 78% boys, including 52 IJO and 51 institutionalized antisocial adolescents, IAA) answered four times a day during 8 days questions about their antisocial behavior, negative affect, impulsivity, and fear of punishment, on a handheld computer. Staff members also regularly reported on each participant’s antisocial behavior. This first application of EMA in IJO overall supported its feasibility, with an excellent participation rate (95%) and a good compliance in completers (84%). About one-third of IJO participants dropped out, with no evidence of sampling bias across a wide range of indicators, while 96% of IAA completed EMA. No reactivity or lack of objectivity was observed. One- to two-thirds of the variance was within-person and reliability was acceptable to good. EMA can thus be reliably used in IJO to study the dynamics of daily antisocial behavior as it naturally unfolds in its context.

MovingU: A prospective cohort study to understand behavioural and environmental contexts influencing physical activity during the transition into emerging adulthood.

BackgroundChildren and youth are often considered the most active segment of the population, however, research indicates that physical activity (PA) tends to peak during the adolescent years, declining thereafter with age. In particular, the acute transition out of high school is a period for which individuals appear to be at high-risk for becoming less active. Relatively few studies have investigated the factors influencing the changes in PA during this transition period. Therefore the purpose of the MovingU study is to gain a comprehensive understanding of the behavioural patterns and the socio-ecological factors related to the changes in PA during the transition out of high school.Methods/DesignMovingU is comprised of two phases. Phase I is a prospective cohort design and aims to follow 120 students in their last year of high school through to their first year out of high school. Students will be asked to complete questionnaires measuring various psychosocial and socio-environmental variables (e.g., self-efficacy and distress) four times throughout this transition period. Students will also be given a wrist-worn accelerometer to wear for 7-days at each of the four assessments. Phase II is a cross-sectional study involving 100 first-year university students. Students will be asked to complete the same questionnaire from phase I, wear a wrist-worn accelerometer for 5-days, and complete ecological momentary assessments (EMA) using their smartphones at randomly selected times throughout the day for 5-days. EMA items will capture information regarding contextual and momentary correlates of PA.DiscussionThe MovingU study represents the first to evaluate the social and environmental influences of PA behaviour changes, including the use of intensive real-time data capture strategies during the transition out of high school. This information will be critical in the development of interventions aimed to prevent or attenuate such drastic declines in PA during emerging adulthood period.

A Randomized Clinical Trial Comparing Individual Cognitive Behavioral Therapy and Child-Centered Therapy for Child Anxiety Disorders

This study compared individual cognitive behavioral therapy (CBT) and a supportive child-centered therapy (CCT) for child anxiety disorders on rates of treatment response and recovery at posttreatment and 1-year follow-up, as well as on real-world measures of emotional functioning. Youth (N = 133; ages 9–14) with anxiety disorders (generalized, separation, and/or social anxiety) were randomized using a 2:1 ratio to CBT (n = 90) or CCT (n = 43), which served as an active comparison. Treatment response and recovery at posttreatment and 1-year follow-up were assessed by Independent Evaluators, and youth completed ecological momentary assessment of daily emotions throughout treatment. The majority of youth in both CBT and CCT were classified as treatment responders (71.1% for CBT, 55.8% for CCT), but youth treated with CBT were significantly more likely to fully recover, no longer meeting diagnostic criteria for any of the targeted anxiety disorders and no longer showing residual symptoms (66.7% for CBT vs. 46.5% for CCT). Youth treated with CBT also reported significantly lower negative emotions associated with recent negative events experienced in daily life during the latter stages of treatment relative to youth treated with CCT. Furthermore, a significantly higher percentage of youth treated with CBT compared to CCT were in recovery at 1-year follow-up (82.2% for CBT vs. 65.1% for CCT). These findings indicate potential benefits of CBT above and beyond supportive therapy on the breadth, generalizability, and durability of treatment-related gains.

Associations Between Anxiety Sensitivity, Negative Affect, and Smoking During a Self-Guided Smoking Cessation Attempt.

Anxiety sensitivity (AS), defined as the extent to which individuals believe anxiety and internal sensations have harmful consequences, is associated with the maintenance and relapse of smoking. Yet, little is known about how AS interplays with negative affect during the quit process in terms of smoking behavior. To address this gap, the current study examined the dynamic interplay between AS, negative affect, and smoking lapse behavior during the course of a self-guided (unaided) quit attempt. Fifty-four participants (33.3% female; M age = 34.6, SD = 13.8) completed ecological momentary assessment procedures, reporting on negative affect and smoking status via a handheld computer device, three times per day for the initial 14 days of the self-guided cessation attempt. As expected, a significant interaction was observed, such that participants characterized by high levels of AS were at a higher risk of smoking on days when negative affect was high (relative to low). Results also revealed a significant interaction between AS and daily smoking lapse behavior in terms of daily change in negative affect. Participants characterized by high levels of AS reported significant increases in same-day negative affect on days when they endorsed smoking relative to days they endorsed abstinence. This study provides novel information about the nature of AS, negative affect, and smoking behavior during a quit attempt. Results suggest there is a need for specialized intervention strategies to enhance smoking outcome among this high-risk group that will meet their unique "affective needs." The current study underscores the importance of developing specialized smoking cessation interventions for smokers with emotional vulnerabilities.

Association of usual self-reported dietary intake with ecological momentary measures of affective and physical feeling states in children

Background: Little is known about the relationship between dietary intake and affective and physical feeling states in children. Purpose: The current study used Ecological Momentary Assessment (EMA) to examine how usual dietary intake is cross-sectionally associated with both average affective and physical feeling state ratings and rating variability in children. Methods: Children (N = 110, mean age = 11.0 ± 1.2 years, 52.5% male, 30.1% Hispanic/Latino) completed EMA measures of affective and physical feeling states 3–7 times per day for a full or partial day (weekday evenings and weekend days and evenings) over a 4-day period. Usual intake of pre-selected dietary components was measured prior to the EMA measurement period using the Block Kids Food Screener. Statistical analyses included mixed models and mixed-effects location scale models. Results: Greater usual fiber intake was cross-sectionally associated with higher average positive affect (PA) ratings, lower variability of NA ratings, and higher variability of physical fatigue ratings. Lower usual glycemic load of diet was cross-sectionally associated with lower variability of NA ratings. Lower usual added sugar intake was cross-sectionally associated with higher average physical energy ratings and lower variability of NA ratings. Conclusions: Although temporal precedence was not established by these findings, they indicate that characteristics of children's usual dietary intake are cross-sectionally associated with both the average and variability of affective and physical feeling states. EMA offers a promising avenue through which to explore the associations between affective states and diet and has the potential to provide insight into nuances of this relationship.

Marijuana use, craving, and academic motivation and performance among college students: An in-the-moment study

IntroductionMarijuana is the most commonly used illicit substance in the U.S., with high rates among young adults in the state of Colorado. Chronic, heavy marijuana use can impact cognitive functioning, which has the potential to influence academic performance of college students. It is possible that craving for marijuana may further contribute to diminished cognitive and affective functioning, thus leading to poor outcomes for students. MethodsCollege student marijuana users (n=57) were recruited based on heavy use and completed ecological momentary assessment (EMA) via text-messaging. The association between marijuana use and craving in a college setting was explored, as well as how these variables might relate to academic motivation, effort and success. The participants were sent text messages for two weeks, three times per day at random times. ResultsA temporal association between craving and marijuana use was found, where momentary craving positively predicted greater marijuana use. Similarly, as craving levels increased, the number of minutes spent studying decreased at the next assessment point. A negative association between momentary craving for marijuana and academic motivation was found in the same moment. Greater academic self-efficacy positively predicted cumulative GPA, while average minutes spent smoking marijuana was negatively related. ConclusionsUsing EMA, marijuana craving and use were significantly related. These findings provide further evidence that heavy marijuana use is negatively associated with academic outcomes.

Real-Time Associations Between Engaging in Leisure and Daily Health and Well-Being.

Engagement in leisure has a wide range of beneficial health effects. Yet, this evidence is derived from between-person methods that do not examine the momentary within-person processes theorized to explain leisure's benefits. This study examined momentary relationships between leisure and health and well-being in daily life. A community sample (n = 115) completed ecological momentary assessments six times a day for three consecutive days. At each measurement, participants indicated if they were engaging in leisure and reported on their mood, interest/boredom, and stress levels. Next, participants collected a saliva sample for cortisol analyses. Heart rate was assessed throughout the study. Multilevel models revealed that participants had more positive and less negative mood, more interest, less stress, and lower heart rate when engaging in leisure than when not. Results suggest multiple mechanisms explaining leisure's effectiveness, which can inform leisure-based interventions to improve health and well-being.

Functional Impairment Variability in Children With ADHD Due to Emotional Impulsivity

Objective: The present study utilized ecological momentary assessment (EMA) to examine the effects of emotional impulsivity on overall functional impairment and functional impairment variability (FIV) of children with and without ADHD. Method: Parents of 74 children, 8- to 12-year-olds (42 with ADHD, 32 without ADHD), completed EMA assessment protocol ratings of their child’s mood (3 times daily) and functional impairment (1 time daily) over the course of 28 days. Results: Hierarchical regression analyses supported the interaction of ADHD diagnostic status and greater EMA-derived emotional impulsivity in the estimation of total functional impairment (Total FI) and FIV. Thus, greater emotional impulsivity was found to be related to greater Total FI and FIV among children with ADHD but not among children without ADHD. Conclusion: This study suggests that children with ADHD and greater emotional impulsivity demonstrate greater overall levels of functional impairment, with the severity of their impairment varying significantly over time.

Relationship between momentary affect states and self-efficacy in adolescent smokers.

Relapse to smoking after making a quit attempt is both common and rapid in adolescent smokers. Momentary self-efficacy (SE)-that is, momentary shifts in one's confidence in the ability to abstain from smoking-predicts the occurrence and timing of relapse among adolescent smokers. Therefore, it is important to identify factors that are associated with changes in momentary SE early in a quit attempt. This study examined the relationship between affect states (including positive, negative, and nicotine withdrawal states) and momentary SE at various stages of a quit attempt. Adolescent daily smokers interested in making a quit attempt (n = 202) completed ecological momentary assessments (EMA) each day for 1 week leading up to and 2 weeks after a quit attempt. In each assessment, they reported current SE and affect state. RESULTS of linear mixed models indicated that most of the examined affect states were related to momentary SE. Contrary to expectation, they were related to momentary SE both immediately before and after the quit attempt. Moderation effects were observed for select affect states, where higher baseline SE was related to lower momentary SE in the presence of increasing negative high activation, boredom, and difficulty concentrating. Our findings suggest that both positive and negative affect states are related to SE, and that thereby positive affect enhancement may be a promising, underutilized treatment target.

Latina adolescent sleep and mood: an ecological momentary assessment pilot study.

Sleep and mood represent two important malleable opportunities for adolescent health. This study investigated the sleep-mood relationship in adolescent girls. Short-term, longitudinal design. Latina adolescents (N = 19, mean age 15) completed ecological momentary assessments on sleep (perceived quality, self-report quantity) and mood (negative affect, positive affect, and positivity ratio). Adolescents sent 1,598 texts on sleep and mood. Bidirectional sleep-mood relationships were in expected directions; negative affect and the positivity ratio affect predicted adolescents' sleep quality. Interventions should encourage sleep-mood relationship awareness, and further research should identify significant differences to inform tailored interventions with adolescents.

Do ethnicity and gender moderate the influence of posttraumatic stress disorder on time to smoking lapse?

BackgroundFollowing a smoking cessation attempt, smokers with posttraumatic stress disorder (PTSD) experience smoking relapse at a higher and faster rate. Black ethnicity and female gender are also associated with lower success rates following smoking cessation. No study to date has prospectively examined how ethnicity and gender may moderate the effect of PTSD on smoking relapse. It was hypothesized that female gender and Black ethnicity would significantly predict early lapse after quitting; further, it was predicted that ethnicity and gender would moderate the effect of PTSD on relapse rate. MethodsSmokers with PTSD (n=48) and without PTSD (n=56) completed ecological momentary assessment (EMA) the week after a quit date, and self-initiated EMA entries after smoking lapse. Smoking abstinence was biologically verified. The sample included Black (62%) and White (38%) participants, and was 50% female. Study hypotheses were tested with Cox proportional hazards regression modeling time to first smoking lapse. ResultsStudy results confirmed the main hypothesis, with a significant PTSD×Ethnicity interaction emerging. The effect of PTSD on smoking relapse was significant for White participants but not for Black participants. No significant gender moderation was found. ConclusionTaken together, study results support previous research, and suggest that the relationship between smoking and PTSD is stronger for White smokers than for minorities. This study has significant implications for research in smoking and mental disease, as well as for smoking cessation treatments for Black smokers.

Peer relationships and diabetes: Retrospective and ecological momentary assessment approaches.

To examine the association of positive and negative aspects of friendship to psychological well-being, self-care behavior, and blood glucose control and to determine whether these relations were moderated by gender. Adolescents with Type 1 diabetes (n = 76) completed baseline measures of friendship quality, depressive symptoms, and self-care. A measure of metabolic control was obtained from medical records. Adolescents also tested blood glucose periodically over the course of 4 days and completed ecological momentary assessments of interpersonal interactions and mood using PDAs. For between-groups analyses, primary outcomes were depressive symptoms, self-care behavior, and metabolic control. For within-groups analyses, primary outcomes were mood and blood glucose. Results showed baseline reports of peer conflict but not support were associated with outcomes, particularly among girls. Conflict was more strongly related to poor metabolic control for girls than boys. Momentary interaction enjoyment and interaction upset were associated with mood, but were unrelated to blood glucose. Aggregate indices of enjoyable interactions were associated with fewer depressive symptoms and better self-care-especially among girls. These results suggest that the positive and negative aspects of peer relationships are related to the psychological well-being and physical health of adolescents with diabetes.