Daily Ecological Momentary Assessment Research Articles

Mobile survey engagement by older adults is high during multiple phases of the COVID-19 pandemic and is predicted by baseline and structural factors.

Digital surveys, such as mobile phone ecological momentary assessment (EMA), bear the potential to assess and target individual wellbeing in a personalized, real-time approach and allow for interaction in situations when in-person contact is not possible, such as during the coronavirus pandemic. While the use of digital technology might especially benefit research in older adults who find themselves in circumstances of reduced mobility, little is known about their barriers to adherence. We investigated baseline and structural factors that predict study withdrawal and adherence from daily smartphone EMA self-report surveys in the StayWELL Study. The StayWELL study is a longitudinal, observational study on the relationship between social restrictions during the coronavirus pandemic and mental well-being in 95 community-dwelling older aged adults (67–87 years) who were participants in a randomized clinical trial using EMA. Withdrawal was associated with less research staff changes and less likely in participants that reached the study mid-point. No baseline characteristics predicted withdrawal. Main reasons for withdrawal were communication issues, i.e. staff not being able to contact participants. We found an adherence rate of 82% and no fatigue effects. Adherence was predicted by education status, study participation duration, reaching the study midpoint and time between study start and enrollment. COVID infections or supporting people in the household was not related to adherence. To conclude, it is feasible to conduct an EMA study in older people without impacting engagement during a pandemic. Furthermore, personal characteristics and smartphone operating system (Android vs. iOS) used did not relate to engagement, allowing for a broad distribution of digital health technologies. Our study adds information on single predictive variables relevant for adherence and withdrawal from EMA smartphone surveys in older people that can inform the design of future digital EMA research to maximize engagement and reliability of study results.

Sleep Patterns and Affect Dynamics Among College Students During the COVID-19 Pandemic: Intensive Longitudinal Study.

BackgroundSleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant.ObjectiveIn an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic.MethodsCollege student participants (N=20; female: 13/20, 65%) wore an Oura ring (Ōura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day.ResultsParticipants with a higher sleep onset latency (b=−1.09, SE 0.36; P=.006) and TST (b=−0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=−0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04).ConclusionsFluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability may be potential pathways through which sleep has implications for mental health.

Change in Adolescents’ Perceived ADHD Symptoms Across 17 Days of Ecological Momentary Assessment

ABSTRACT Objective To test whether adolescents’ perceived ADHD symptoms may improve while monitoring them throughout the day. Method In a sample of 90 adolescents (M age = 14.7; 66% boys, 34% girls; 76.7% White, 13.3% Black or African American, 8.9% more than one race, 1.1% “other”) treated for ADHD by their pediatricians, this study examined: (1) whether self-rated ADHD symptoms decreased across 17 days of 4 times daily ecological momentary assessment (EMA) of symptoms and (2) whether completing versus missing an EMA survey was associated with lower self-rated ADHD symptoms in the subsequent hours. Results Multilevel regression analyses showed that, on average, adolescents’ perceived ADHD symptoms (inattention, hyperactivity, impulsivity, and total across domains) decreased across 17 days of EMA. Within person, symptoms were lower following completed versus missed EMA surveys. Significant moderating effects showed that the effect of completing the prior EMA survey weakened across the day and over the course of the 17 days. Conclusions This study is the first to document acute improvements in self-rated ADHD symptoms using EMA in adolescents’ naturalistic environments. Symptom monitoring throughout the day may help adolescents improve their day-to-day ADHD, at least acutely, and holds promise as one component of mobile-health ADHD interventions.

The role of anxiety and gender in anticipation and avoidance of naturalistic anxiety-provoking experiences during adolescence: An ecological momentary assessment study.

Anxiety symptoms often increase in late childhood/early adolescence, particularly among girls. However, few studies examine anxiety-relevant gender differences during anticipation and avoidance of naturalistic experiences during adolescence. The current study uses ecological momentary assessment (EMA) to examine associations among clinical anxiety, gender, anticipation, and attempted avoidance of person-specific anxiety-provoking experiences in youth ages 8-18. 124 youth (73 girls) completed 7 consecutive days of EMA. Seventy participants (42 girls) met criteria for one or more anxiety disorders, while the remaining 54 were healthy controls (31 girls). Participants reported the experience that they were "most worried about happening that day" and completed ratings about that event including whether they attempted to avoid that experience. Multilevel models examined whether diagnostic group (anxious, healthy), gender (boys, girls), or their interaction predicted anticipatory ratings or avoidance of these experiences. Analyses revealed significant diagnostic group by gender interactions for anticipatory ratings. Specifically, anxious girls reported greater worry and predicted more negative outcomes related to future experiences. However, only a main effect of diagnostic group emerged for attempted avoidance. Finally, anticipatory worry predicted higher rates of attempted avoidance, but this association did not vary by diagnostic group, gender, or their interaction. These findings extend the literature on the interplay of anticipation and avoidance to person-specific naturalistic experiences in pediatric anxiety. They reveal that anxious girls report more anticipatory anxiety and worry, while avoidance of real-world anxiety-provoking scenarios is a key concern for anxious youth independent of gender. By using EMA to examine person-specific anxiety-inducing experiences we can begin to understand how these processes and experiences unfold in the real world.

Psychosocial Impact of the COVID-19 Pandemic on People With Type 1 Diabetes: Results of an Ecological Momentary Assessment Study.

Psychological distress due to living with diabetes, demanding self-management tasks, impacts on life, and risks of complications is common among people living with diabetes. COVID-19 could pose a new additional risk factor for psychological distress in this group. This study aimed to analyze levels of COVID-19-related burdens and fears, variables explaining these levels, and associations with the concurrent 7-day COVID-19 incidence in people with type 1 diabetes (T1D). A total of 113 people with T1D (58% women; age: 42.3 ± 9.9 years) participated in an ecological momentary assessment (EMA) study between December 2020 and March 2021. The participants reported daily levels of COVID-19-related burdens and fears over 10 consecutive days. Global ratings of COVID-19-related burdens and fears were assessed using questionnaires, as were current and previous levels of diabetes distress (PAID), acceptance (DAS), fear of complications (FCQ), depressive symptoms (CES-D), and diabetes self-management (DSMQ). Current levels of diabetes distress and depressive symptoms were compared with pre-pandemic ratings gained during an earlier study phase. Associations between burdens and fears, psychosocial and somatic aspects, and the concurrent 7-day incidence rate were analyzed using multilevel regression. Diabetes distress and depressive symptoms reported during the pandemic were comparable to pre-pandemic levels (PAID: p = .89; CES-D: p = .38). Daily EMA ratings reflected relatively low mean COVID-19-related burdens and fears in everyday life. However, there was substantial day-to-day variation per person indicating higher burdens on specific days. Multilevel analyses showed that daily COVID-19-related burdens and fears were significantly predicted by pre-pandemic levels of diabetes distress and diabetes acceptance but were not associated with the concurrent 7-day incidence rate nor with demographic and medical variables. This study observed no increase in diabetes distress and depressive symptoms during the pandemic in people with T1D. The participants reported low to moderate levels of COVID-19-related burdens. COVID-19-related burdens and fears could be explained by pre-pandemic levels of diabetes distress and acceptance but not by demographic and clinical risk variables. The findings suggest that mental factors may constitute stronger predictors of COVID-19-related burdens and fears than objective somatic conditions and risks in middle-aged adults with T1D.

Effectiveness and cost-effectiveness of a web-based routine assessment with integrated recommendations for action for depression and anxiety (RehaCAT+): protocol for a cluster randomised controlled trial for patients with elevated depressive symptoms in rehabilitation facilities

IntroductionThe integration of a web-based computer-adaptive patient-reported outcome test (CAT) platform with persuasive design optimised features including recommendations for action into routine healthcare could provide a promising way to translate...

711-P: User Acceptability of Ecological Momentary Assessment to Report Hypoglycemia over Ten Weeks Using a Novel Smartphone Application in the Hypo-METRICS Study: Hypoglycemia Measurements, Thresholds and Impacts

Background: Hypoglycemia and its impact on people with diabetes is typically reported retrospectively and is subject to recall bias. Ecological momentary assessment (EMA) uses repeated sampling to collect real time, granular data about patient experiences, typically over 3-5 days. We developed the Hypo-METRICS app to determine the physical, psychological, and economic impact in people with type 1 (T1D) and type 2 diabetes (T2D) over weeks using EMA. We tested user acceptability of the Hypo-METRICS app. Methods: We recruited 323 adults (T1D=186, T2D=137, 55% men, mean age 54±16 years, diabetes duration 22±13 years) using insulin with ≥1 episode of hypoglycemia in the last month. Participants were prompted to complete three daily EMA and two weekly questionnaires (the Work Productivity and Activity Impairment Questionnaire and PROMIS Sleep Disturbance scale) for weeks. EMA included 29 items over morning, afternoon and evening time points. EMA questions spanned seven categories including experience of hypoglycemia, sleep, and daily functioning. Participants recorded hypoglycemia episodes using a symptom tracker in real time. Results: The overall mean completion rate was 89±10% (T1D=87±11%, T2D=91±8%) , with 86,487 completed items. EMAs had a completion rate of 88±11% (T1D=87±11% T2D=90±9%) . Weekly questionnaires had a completion rate of 92±11% (T1D=91±12 T2D=95±8) . A total of 5,585 episodes of participant-reported hypoglycemia (T1D=4,118, T2D=1,467) were recorded in real time with a mean of 1.7±1.4 episodes reported per participant/week (T1D=2.2±1.4 T2D=1.1±1.0) . Conclusion: The Hypo-METRICS app is an acceptable tool to collect prospective detailed data on the frequency of hypoglycemia episodes and their impact on daily functioning over a prolonged period. Disclosure N.Zaremba: None. R.J.Mccrimmon: Advisory Panel; Novo Nordisk, Sanofi, Research Support; Diabetes UK, European Union, MedImmune. E.Renard: Consultant; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Insulet Corporation, LifeScan, Lilly, Novo Nordisk, Roche Diabetes Care, Sanofi, Tandem Diabetes Care, Inc. S.R.Heller: Advisory Panel; Eli Lilly and Company, Medtronic, Mylan N.V., Zealand Pharma A/S, Zucara Therapeutics, Other Relationship; Eli Lilly and Company, Research Support; Dexcom, Inc., Speaker's Bureau; Novo Nordisk A/S. M.Evans: Advisory Panel; Pila Pharma, Zucara Therapeutics, Other Relationship; Abbott Diabetes, Dexcom, Inc., Medtronic, Novo Nordisk, Research Support; AstraZeneca, Sanofi, Speaker's Bureau; Lilly Diabetes. J.K.Mader: Advisory Panel; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Abbott Diabetes, Eli Lilly and Company, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Servier Laboratories, Stock/Shareholder; decide Clinical Software GmbH. A.Seibold: Employee; Abbott Diabetes, Stock/Shareholder; Abbott. S.A.Amiel: Advisory Panel; Medtronic, Novo Nordisk, Other Relationship; Sanofi. P.Choudhary: Advisory Panel; Abbott Diabetes, Lilly Diabetes, Medtronic, Research Support; Novo Nordisk, Speaker's Bureau; Dexcom, Inc., Glooko, Inc., Insulet Corporation, Sanofi. Hypo-resolve consortium: n/a. G.Martine-edith: Other Relationship; Novo Nordisk. P.Divilly: None. Z.Mahmoudi: Employee; Novo Nordisk A/S. U.Soeholm: Research Support; Novo Nordisk A/S. M.M.Broadley: None. F.Pouwer: Research Support; Eli Lilly and Company, Novo Nordisk, Sanofi. B.E.De galan: Research Support; Novo Nordisk. U.Pedersen-bjergaard: Advisory Panel; Novo Nordisk A/S, Sanofi. Funding Innovative Medicines Initiative (777460)

0257 Testing the directionality of sleep and stress during the perinatal period: what's the impact on perinatal depression?

Abstract Introduction Pregnancy is a time of pronounced sleep disturbance, with a majority (~85%) of women endorsing shorter, more fragmented sleep as gestation progresses. While new-onset antenatal depression (AND) is a known risk factor for postpartum depression, its etiology remains less understood, despite well-established evidence that incidence is the same among healthy first-time mothers as compared to women with established riskfactors inclusive of family or personal history of psychopathology. Heightened daily stress appraisals may be one critical pathway through which disrupted sleep gives rise to AND. The current study tested the directionality of the relationship between habitual nighttime sleep parameters and daytime stress ratings using a prospective amulatory field study design. Methods Fifty primiparous women (38% White; 32% Black; 30% Other race/ethnicity; mean age = 32 years, 28 weeks gestation) without a history of sleep disorders nor psychopathology completed 10-days (9-nights) of actigraphy and sleep diaries. They also engaged in 3-days of superimposed ecological momentary assessments (EMA) rating stress, positive, and negative affect at four intervals throughout the day. Analyses examined negative affective responses to social conflict and task-based demand througout days of EMA, at the within-person and between-women levels. Sleep variables explored included total sleep time (TST), sleep efficiency (SE; log-transformed), sleep onset latency (SOL) and sleep quality as measured by the Pittsburgh Sleep Quality Index. Cross-lagged hierarchical mixed models tested directionality of sleep-stress relationship. Time-varying covariates included time-of-day, previous day stress for sleep outcomes, and previous night sleep for stress outcomes, at the within-person levels. Results After days of greater stress (demand and conflict), women experienced significantly shorter, less efficient sleep and took longer to fall asleep (by both diary and actigraphy; [Beta(SE)=-6.3(1.4); 1.2(.12,), R^2=.27, .32, respectively; ps<.01]. Following nights of shorter sleep, women endorsed greater negative affective responses to stress (Beta=.12, SE=.01, p<.001; R^2=.27). Over the assessment period, women who had shorter, less efficient sleep experienced greater frequency, higher severity stressors, after adjusting for time-of-day, and baseline sleep characteristics, depression and anxiety levels (Betas = -7.4(2.6); .14(.01), ps<.001, respectively). Given this bidirectional support, stress was examined as a moderator of the relationship between TST and depression severity at 34-36 weeks gestation, indicating that greater stress explained the relationship between shorter TST and heightened AND after adjustment for baseline measures. Conclusion This is the first study to explore directionality of sleep-stress relationships in a perinatal sample; results provide support for the idea that heightened daily stress engenders greater sleep disturbance (difficulty initiating and maintaining sleep; shorter duration). Bidirectional support for shorter sleep duration and increased stress appraisal was also found. The current project provides preliminary evidence for stress "spill-over" effects (i.e., stress transmission) as a potential mechanism for heightened antenatal depression symptoms. Support (If Any) NIMH 1R36MH118000-01, CTSI89431, SRS Mentor/Mentee Grant; T32 HL007713

High-Risk Drinkers Engage Distinct Stress-Predictive Brain Networks

BackgroundExcessive alcohol intake is a major public health problem and can be triggered by stress. Heavy drinking in patients with alcohol use disorder also alters neural, physiological, and emotional stress responses. However, it is unclear whether adaptations in stress-predictive brain networks can be an early marker of risky drinking behavior. MethodsRisky social drinkers (regular bingers; n = 53) and light drinker control subjects (n = 51) aged 18 to 53 years completed a functional magnetic resonance imaging–based sustained stress protocol with repeated measures of subjective stress state, during which whole-brain functional connectivity was computed. This was followed by prospective daily ecological momentary assessment for 30 days. We used brain computational predictive modeling with cross-validation to identify unique brain connectivity predictors of stress in risky drinkers and determine the prospective utility of stress-brain networks for subsequent loss of control over drinking. ResultsRisky drinkers had anatomically and functionally distinct stress-predictive brain networks (showing stronger predictions from visual and motor networks) compared with light drinkers (default mode and frontoparietal networks). Stress-predictive brain networks defined for risky drinkers selectively predicted future real-world stress levels for risky drinkers and successfully predicted prospective future real-world loss of control over drinking across all participants. ConclusionsThese results indicate adaptations in computationally derived stress-related brain circuitry among high-risk drinkers, suggesting potential targets for early preventive intervention and revealing the malleability of the neural processes that govern stress responses.

Feasibility and Acceptability of Ecological Momentary Assessment of Psychosocial Factors and Self-Management Behaviors Among Veterans With Type 2 Diabetes.

Comorbid symptoms such as post-traumatic stress and pain are common barriers to optimal self-management among veterans with type 2 diabetes. Additionally, self-management behaviors occur in the context of veterans' daily routines and social environments. This study evaluated the feasibility and acceptability of ecological momentary assessment (EMA) among veterans with type 2 diabetes. Ten veterans with type 2 diabetes were asked to respond to random EMA surveys during preprogrammed intervals five times per day for 14 days. EMA surveys were delivered via a mobile application and assessed momentary physical location, activities, social interactions, mood, stress, and pain. The last survey of each day included additional items about daily post-traumatic stress symptoms, diabetes distress, social support, physical activity, self-management behaviors, and functioning. Participants completed interviews assessing their experience in the study and barriers to responding and indicated their likelihood of participating in similar studies. The mean survey response rate was 96%, providing 675 observations. The majority of participants completed the five momentary surveys in <1 minute and the daily EMA surveys in <5 minutes. Results revealed substantial individual day-to-day variability across symptoms and self-management behaviors that is not captured by aggregated means across all participants. Participants generally reported enjoying responding to surveys and experiencing few barriers. Nine of 10 participants reported being "extremely likely" to participate in a similar study. These pilot data suggest that intensive EMA designs are feasible and acceptable for veterans with type 2 diabetes and can inform the design of future larger studies.

Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study

BackgroundYouth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many “in-person” coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use.ObjectiveThis is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population.MethodsThe participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple’s daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores.ResultsA total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization.ConclusionsOur findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU.

Subgenual Anterior Cingulate Cortex Reactivity to Rejection Vs. Acceptance Predicts Depressive Symptoms among Adolescents with an Anxiety History

ABSTRACT Objective The goal of this study was to examine whether neural sensitivity to negative peer evaluation conveys risk for depression among youth with a history of anxiety. We hypothesized that brain activation in regions that process affective salience in response to rejection, relative to acceptance, from virtual peers would predict depressive symptoms 1 year later and would be associated with ecological momentary assessment (EMA) reports of peer connectedness. Method Participants were 38 adolescents ages 11–16 (50% female) with a history of anxiety, recruited from a previous clinical trial. The study was a prospective naturalistic follow-up of depressive symptoms assessed 2 years (Wave 2) and 3 years (Wave 3) following treatment. At Wave 2, participants completed the Chatroom Interact Task during neuroimaging and 16 days of EMA. Results Controlling for depressive and anxiety symptoms at Wave 2, subgenual anterior cingulate (sgACC; β = .39, p = .010) activation to peer rejection (vs. acceptance) predicted depressive symptoms at Wave 3. SgACC activation to rejection (vs. acceptance) was highly negatively correlated with EMA reports of connectedness with peers in daily life (r = – .71, p < .001). Conclusion Findings suggest that elevated sgACC activation to negative, relative to positive, peer evaluation may serve as a risk factor for depressive symptoms among youth with a history of anxiety, perhaps by promoting vigilance or reactivity to social evaluative threats. SgACC activation to simulated peer evaluation appears to have implications for understanding how adolescents experience their daily social environments in ways that could contribute to depressive symptoms.

Deconstructing emotion regulation in schizophrenia: The nature and consequences of abnormalities in monitoring dynamics

Prior studies implicate abnormalities at the identification, selection, and implementation stages of Gross’ extended process model of emotion regulation in schizophrenia. However, it is unclear whether monitoring dynamics (i.e., emotion regulation maintenance, switching, and stopping), another critical component of the model, are also abnormal or what predicts those abnormalities. The current study evaluated switching (i.e., switching to a different emotion regulation strategy because the initial strategy was not effective) and stopping dynamics (i.e., terminating the implementation of an emotion regulation strategy) and their associated mechanisms using 6 days of ecological momentary assessment in 47 outpatients with schizophrenia or schizoaffective disorder (SZ) and 52 healthy controls (CN). Results indicated that individuals with SZ exhibited excessive switching between emotion regulation strategies and delayed stopping compared to CN, self-efficacy moderated group differences in stopping abnormalities, and switching and stopping abnormalities were associated with different patterns of state-level positive and negative symptoms in SZ. Findings may inform psychosocial emotion regulation therapies for SZ that could incorporate elements for monitoring dynamics and associated mechanisms.

Linguistic analysis of Latinx patients’ responses to a text messaging adjunct during cognitive behavioral therapy for depression

Cognitive behavioral therapy (CBT) is efficacious to treat depression, however more research is needed to understand its functions among Latinxs. This study analyzed qualitative responses that were paired with a mood rating (1–9 scale) from daily ecological momentary assessments via text-messaging of 52 low-income, Spanish-speaking patients to assess the relationship between word use and changes in mood during group CBT. Based on previous research, we chose 11 linguistic dimensions from the Linguistic Inquiry and Word Count text analysis software that conceptually related to core CBT treatment elements and sociocultural factors of depression in Latinxs. Results showed that the use of words from the categories of Friends, Religion, Positive Emotions, and Leisure (proxy for behavioral activation) were significantly associated with a significant increase in mood. The use of Negative Emotions and Health words were significantly associated with a significant decrease in mood. Post-hoc analysis revealed that Certainty (proxy for cognitive inflexibility) words were related to a significant decrease in mood when Negative Emotional words were present. Findings contribute to our understanding of the role of sociocultural factors and core CBT elements in changes in mood among Latinxs. Lastly, this paper demonstrates the potential for analyzing language content during a digital health intervention to better understand user experiences.

Randomized clinical trial of a brief, scalable intervention for mental health sequelae in college students during the COVID-19 pandemic

This randomized clinical trial aimed to determine feasibility, acceptability, and initial efficacy of brief Dialectical Behavior Therapy (DBT) skills videos in reducing psychological distress among college students during the COVID-19 pandemic. Over six weeks, 153 undergraduates at a large, public American university completed pre-assessment, intervention, and post-assessment periods. During the intervention, participants were randomized to receive animated DBT skills videos for 14 successive days (n = 99) or continue assessment (n = 54). All participants received 4x daily ecological momentary assessments on affect, self-efficacy of managing emotions, and unbearableness of emotions. The study was feasible and the intervention was acceptable, as demonstrated by moderate to high compliance rates and video ratings. There were significant pre-post video reductions in negative affect and increases in positive affect. There was a significant time × condition interaction on unbearableness of emotions; control participants rated their emotions as more unbearable in the last four vs. first two weeks, whereas the intervention participants did not rate their emotions as any more unbearable. Main effects of condition on negative affect and self-efficacy were not significant. DBT skills videos may help college students avoid worsening mental health. This brief, highly scalable intervention could extend the reach of mental health treatment.

Associations of Daily Sleep and Stress With Rumination: An Ecological Momentary Assessment and Actigraphy Study

Unconstructive repetitive thoughts are indicative of rumination about daily experiences. Given that poor sleep is associated with greater reactivity to daily stressors, we examined joint associations of daily sleep and stress with daily rumination. 143 nurses completed 14 days of ecological momentary assessments (EMA; assessments of daily sleep, stress, and rumination) and actigraphy. After controlling for age, sex, education, income, inpatient vs. outpatient nurse, workday, and day vs. night shift, there were significant joint associations of sleep and stress with daily rumination. Daily rumination was lowest when lower (-1SD) stressor severity or stressor frequency were paired with longer (+1SD) EMA or actigraphy sleep duration. Daily rumination was highest when higher stressor frequency was paired with higher actigraphy wake after sleep onset (i.e., poorer sleep quality). Future studies should assess whether rumination about daily experiences is associated with quality of patient care provided by nurses in a hospital setting.

Sleep quality is associated with emotion experience and adaptive regulation of positive emotion: An experience sampling study.

Poor sleep patterns have been strongly linked to disrupted emotional experiences. Emotion regulation, defined as the capacity to manage one's own emotional responses, comprises strategies to increase, maintain, or decrease the intensity, duration, and trajectory of positive and negative emotions. Poor sleep has been identified as a risk factor for emotional dysregulation, but most of the focus has been on negative emotion regulation. We therefore asked whether natural variations in sleep are associated with the experience and regulation of both positive and negative emotion. Young adults, aged between 18-24 years (N=101), completed 7days of ecological momentary assessments using a smartphone application. Duration and quality of the previous night's sleep was reported each morning. Levels of positive and negative emotions, and strategies used to regulate emotions, were measured at pseudorandom timepoints four times a day. Multilevel modelling indicated that higher self-reported sleep quality was significantly associated with increased intensity and duration of positive emotion, and decreased intensity of negative emotion. There were no statistically significant associations between sleep duration and emotion intensity or duration. Sleep quality, and not sleep duration, was also associated with the reported use of positive emotion regulation strategies. For negative emotion regulation strategy use, we found no associations with sleep quality or duration. Naturally occurring fluctuations in daily sleep quality may be important for the experience and regulation of positive emotion in young adults. These findings emphasise the need to examine both positive and negative emotion, and emotion regulation to understand the links between sleep and mood.

Feasibility and acceptability of ecological momentary assessment in a fully online study of community-based adults at high risk for suicide.

Ecological momentary assessment (EMA) has increasingly been used to examine suicidality in naturalistic environments. Despite its potential to yield clinically relevant information, no EMA study has used an anonymous, fully online, design. This study reports on the feasibility and acceptability of real-time monitoring of suicide risk among 237 high-risk, anonymous, community-based adults (N = 237, 61.6% female, Mage = 27.12 years) who responded to six daily EMA prompts for 2 weeks. A subset (N = 69) completed a poststudy feedback survey to provide information on the acceptability of the study protocol. Response rates to EMA prompts (69.1%) demonstrated the feasibility of this design. Suicidal ideation was reported in 21.5% of prompts and by 86.1% of participants. Participants reported that their overall experience was positive, and that they would be willing to participate in a similar study again. Specific strengths and limitations of the study design were discussed in response to open-ended items. Finally, participants who created an alias email to ensure anonymity were less likely to report a suicide attempt (SA) history and more likely to complete the study. Overall, intensive EMA designs are feasible and acceptable when delivered online and to anonymous participants. Specific recommendations are provided for managing safety within these study designs, and for refinements in future work. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An App-Based Mindfulness-Based Self-compassion Program to Support Caregivers of People With Dementia: Participatory Feasibility Study.

BackgroundThe number of persons with dementia is steadily growing, as is the number of individuals supporting persons with dementia. Primary caregivers of persons with dementia are most often family members or spouses of the persons with dementia, and they are more likely to experience increased stress and other negative effects than individuals who are not primary caregivers. Although in-person support groups have been shown to help buffer the negative impacts of caregiving, some caregivers live in isolated or rural communities and are unable to make the burdensome commitment of traveling to cities. Using an interdisciplinary approach, we developed a mobile smartphone support app designed for primary caregivers of persons with dementia, with the goal of reducing caregiver burden and easing stress. The app features a 12-week intervention, largely rooted in mindfulness-based self-compassion (MBSC), because MBSC has been linked to minimizing stress, depression, and anxiety.ObjectiveThe primary objectives of our program are twofold: to explore the feasibility of a 12-week mobile support program and to conduct an initial efficacy evaluation of changes in perceived caregiver burden, coping styles, and emotional well-being of caregivers before and after the program.MethodsOur feasibility study used a 2-phase participatory pretest and posttest design, focusing on acceptability, demand, practicality, implementation, and efficacy. At phase I, we recruited 57 primary caregivers of persons with dementia (mean age 76.3, SD 12.9 years), comprising spouses (21/57, 37%), children (21/57, 37%), and friends or relatives (15/57, 26%) of persons with dementia, of whom 29 (51%) completed all measures at both pre- and postprogram. The content of the program featured a series of MBSC podcasts. Our primary outcome measure was caregiver burden, with secondary outcome measures including coping styles and emotional well-being. Daily ecological momentary assessments enabled us to ask participants, “How are you feeling today?” Phase II of our study involved semistructured follow-up interviews with most participants (n=21) who completed phase I.ResultsOur findings suggest that our app or program meets the feasibility criteria examined. Notably, participants generally accepted the program and believed it could be a useful resource. Emotional well-being increased significantly (P=.04), and emotion-based coping significantly decreased (P=.01). Participants generally considered the app or program to be a helpful resource.ConclusionsAlthough there were no significant changes in caregiver burden, we were encouraged by the increased emotional well-being of our participants following the completion of our program. We also conclude that our app or program demonstrated feasibility (ie, acceptability, practicality, implementation, and efficacy) and can provide a much-needed resource for primary caregivers of persons with dementia. In the subsequent version of the program, we will respond to participant feedback by incorporating web-based weekly sessions and incorporating an outcome measure of self-compassion.

An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial.

BackgroundEmotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot—in the form of an interactive plush toy—that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children’s emotion regulation routines, there is no quantitative evidence of the intervention’s impact on child outcomes.ObjectiveThe aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation—Purrble—that can be deployed across prevention and treatment contexts.MethodsOverall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents’ rating of child dysregulation will be ≥10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child’s emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30% of the sample) will be interviewed after deployment as part of the process analysis.ResultsThe study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022.ConclusionsThis study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization.Trial RegistrationClinicalTrials.gov NCT04810455; http://clinicaltrials.gov/ct2/show/NCT04810455International Registered Report Identifier (IRRID)PRR1-10.2196/28914