Ecological Momentary Assessment Designs Research Articles

M-Path: an easy-to-use and highly tailorable platform for ecological momentary assessment and intervention in behavioral research and clinical practice.

In this paper, we present m-Path (www.m-Path.io), an online platform that provides an easy-to-use and highly tailorable framework for implementing smartphone-based ecological momentary assessment (EMA) and intervention (EMI) in both research and clinical practice in the context of blended care. Because real-time monitoring and intervention in people's everyday lives have unparalleled benefits compared to traditional data collection techniques (e.g., retrospective surveys or lab-based experiments), EMA and EMI have become popular in recent years. Although a surge in the use of these methods has led to a myriad of EMA and EMI applications, many existing platforms only focus on a single aspect of daily life data collection (e.g., assessment vs. intervention, active self-report vs. passive mobile sensing, research-dedicated vs. clinically-oriented tools). With m-Path, we aim to integrate all of these facets into a single platform, as it is exactly this all-in-one approach that fosters the clinical utility of accumulated scientific knowledge. To this end, we offer a comprehensive platform to set up complex and highly adjustable EMA and EMI designs with advanced functionalities, using an intuitive point-and click web interface that is accessible for researchers and clinicians with limited programming skills. We discuss the strengths of daily life data collection and intervention in general and m-Path in particular. We describe the regular workflow to set up an EMA or EMI design within the m-Path framework, and summarize both the basic functionalities and more advanced features of our software.

Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study

IntroductionAdolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support...

"Buffering traumatic reactions to COVID-19: Mindfulness moderates the relationship between the severity of the pandemic and posttraumatic stress symptoms": Correction.

As an international public health emergency panic, Corona Virus Disease-19 (COVID-19) has caused substantial impacts on economic and daily life. The public were at high risk of mental health problems and posttraumatic stress symptoms (PTSS). This study aimed to evaluate the association between objective/subjective severity of COVID-19 pandemic and PTSS, and explore the moderating role of mindfulness. Using longitudinal and 7-day ecological momentary assessment (EMA) designs, we gathered data from 109 college students who were home-quarantined to examined study hypotheses. In the EMA phase, participants completed questionnaires measuring subjective severity, mindfulness and PTSS three times per day. Objective severity was indicated using the daily new confirmed cases. Then participants completed a follow-up measure of PTSS 2 months later, when the epidemic initially became stable. The results of structural equation modeling showed that state mindfulness moderated the relationship between subjectivity severity of COVID-19 and PTSS. Specifically, the association between subjective severity of COVID-19 and PTSS was positive at the low level of state mindfulness, and negative at the high level of state mindfulness. Trait mindfulness did not moderate the relationship between objectivity severity of COVID-19 and PTSS. Mindfulness-based interventions can be used as preventive mental health education to the daily lives of the general public, and to deal with unpredictable crisis events. Implications of this study are drawn for theory, practice, and research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Buffering traumatic reactions to COVID-19: Mindfulness moderates the relationship between the severity of the pandemic and posttraumatic stress symptoms.

Using longitudinal and 7-day ecological momentary assessment (EMA) designs, we gathered data from 109 college students who were home-quarantined to examined study hypotheses. In the EMA phase, participants completed questionnaires measuring subjective severity, mindfulness and PTSS three times per day. Objective severity was indicated using the daily new confirmed cases. Then participants completed a follow-up measure of PTSS 2 months later, when the epidemic initially became stable. The results of structural equation modeling showed that state mindfulness moderated the relationship between subjectivity severity of COVID-19 and PTSS. Specifically, the association between subjective severity of COVID-19 and PTSS was positive at the low level of state mindfulness, and negative at the high level of state mindfulness. Trait mindfulness did not moderate the relationship between objectivity severity of COVID-19 and PTSS. Mindfulness-based interventions can be used as preventive mental health education to the daily lives of the general public, and to deal with unpredictable crisis events. Implications of this study are drawn for theory, practice, and research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Testing the Mindfulness-to-Meaning Theory in Daily Life

ObjectivesThe mindfulness-to-meaning theory (MMT) describes the processes through which mindfulness leads to enhanced eudaimonic wellbeing (indirectly via mediating processes such as increased decentering, reappraisal, positive affect, and savoring), but little is currently known about how these processes impact one another over short time periods (e.g., across several hours). The current study tested the MMT by measuring these variables repeatedly as they occur naturalistically in daily life.MethodsThree hundred and forty-five community members aged 18–65 completed surveys on smartphones six times per day over 7 days, assessing their current levels of decentering, reappraisal, positive affect, savoring, and wellbeing, as part of a larger study. Multilevel structural equation modeling in Mplus was used to analyze the nested data with mediation models.ResultsThere was a significant indirect effect through the proposed MMT pathway at the within-person level, with all variables measured concurrently. Lagged mediation examining prospective effects indicated that the full indirect MMT pathway was not significant in predicting later wellbeing, though some individual indirect pathways were significant prospectively. Follow-up analyses testing alternative temporal ordering suggested bidirectional effects of savoring and positive affect in explaining the mutual association between decentering and wellbeing.ConclusionsOverall, this study found support for hypothesized MMT processes in daily life and measured over short time periods, with evidence for bidirectional effects for some processes. However, reappraisal showed inconsistent effects, requiring further study and replication using ecological momentary assessment designs.

Dysphoria and well-being in daily life: Development and validation of ecological momentary assessment scales.

Assessment of internalizing symptoms has generally relied on cross-sectional and retrospective self-reports, but ecological momentary assessment (EMA) is increasingly used to capture quick fluctuations in symptoms, enhance ecological validity, and improve recall accuracy. However, there are very few measures of internalizing symptoms that have been validated for use in EMA designs. In Study 1, we chose candidate items for EMA short forms of the Dysphoria and Well-Being scales from the Inventory of Depression and Anxiety Symptoms (IDAS), based on principal factor analyses and internal consistency analyses conducted on aggregated cross-sectional datasets (total N = 8,876). In Study 2, we tested the items using an EMA design in a sample of college students (N = 279) oversampled for elevated neuroticism. Scale structure, reliability, and convergent and discriminant validity (regarding baseline IDAS scales, baseline affect, and EMA affect) were evaluated at the within- and between-person levels using multilevel structural equation modeling. Exploratory and confirmatory factor analyses in separate subsamples revealed the expected two-factor structure, yielding a four-item Well-Being scale and a five-item Dysphoria scale. Both scales showed acceptable to good internal consistency, strong convergent validity, and generally adequate discriminant validity. However, some associations of the new scales with EMA affect (i.e., Dysphoria with negative affect; Well-Being with positive affect) were very strong at the between-person level, such that they were not empirically distinct. Overall, this study provides an initial validation of brief EMA-IDAS Dysphoria and Well-Being scales that can be used in research or clinical settings, with particular utility for capturing within-person, dynamic effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

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).

Use of mHealth Technology for Patient-Reported Outcomes in Community-Dwelling Adults with Acquired Brain Injuries: A Scoping Review.

The purpose of our scoping review was to describe the current use of mHealth technology for long-term assessment of patient-reported outcomes in community-dwelling individuals with acquired brain injury (ABI). Following PRISMA guidelines, we conducted a scoping review of literature meeting these criteria: (1) civilians or military veterans, all ages; (2) self-reported or caregiver-reported outcomes assessed via mobile device in the community (not exclusively clinic/hospital); (3) published in English; (4) published in 2015–2019. We searched Ovid MEDLINE(R) < 1946 to 16 August 2019, MEDLINE InProcess, EPub, Embase, and PsycINFO databases for articles. Thirteen manuscripts representing 12 distinct studies were organized by type of ABI [traumatic brain injury (TBI) and stroke] to extract outcomes, mHealth technology used, design, and inclusion of ecological momentary assessment (EMA). Outcomes included post-concussive, depressive, and affective symptoms, fatigue, daily activities, stroke risk factors, and cognitive exertion. Overall, collecting patient-reported outcomes via mHealth was feasible and acceptable in the chronic ABI population. Studies consistently showed advantage for using EMA despite variability in EMA timing/schedules. To ensure best clinical measurement, research on post-ABI outcomes should consider EMA designs (versus single time-point assessments) that provide the best timing schedules for their respective aims and outcomes and that leverage mHealth for data collection.

Coping Motivated Alcohol Use: The Role of Social Anxiety and Dissociation

abstract Background: Social anxiety has been associated with higher rates of negative alcohol use consequences, and this relationship appears to be accounted for by coping drinking motives. Dissociation is commonly present in anxiety disorders, including social anxiety disorder, and may serve to unconsciously reduce negative emotions when more effortful coping strategies are not effective. Objectives: The present study examined whether the relationship between social anxiety, coping motives, and alcohol consequences was moderated by dissociative symptoms. It was hypothesized that coping motives would mediate the relationship between social anxiety and alcohol consequences, and that dissociation would moderate the relationship between social anxiety and coping motives. Undergraduate students who endorsed alcohol use within the past 30 days (n = 320) were recruited from a large public university. Participants completed measures of social anxiety, dissociation, alcohol motives, and alcohol consequences as part of a larger online questionnaire. Results: Coping motives were found to mediate the relationship between social anxiety and alcohol consequences. Dissociation did not moderate the relationship between social anxiety and coping motives. Dissociation was significantly associated with alcohol consequences via coping motives. Conclusions: Future research should include longitudinal research designs or ecological momentary assessment designs and should examine these relationships in clinical and community samples.

Feasibility and Acceptability of Ecological Momentary Assessment with High-Risk Suicidal Adolescents Following Acute Psychiatric Care

ABSTRACT Objective: The study purpose was to examine the feasibility and acceptability of intensive ecological momentary assessment (EMA) among high-risk adolescents with suicidal thoughts and behaviors following discharge from acute psychiatric care. Method: Fifty-three adolescents, 12–18 years old, and their parents, were recruited following discharge from acute psychiatric care for suicide risk. The study included a baseline assessment (adolescent and parent), 28 days of EMA surveys (5x per day) and wrist actigraphy (adolescent), and an interview at the end of the 28-day monitoring period (adolescent). Adolescents’ outpatient clinicians were also surveyed about the study. Results: Study feasibility was indicated by a reasonable enrollment rate, high adherence to wearing the actigraphy device, and good adherence to EMA surveys (highest in the first week with significant drop-off in subsequent weeks). Adolescents reported their overall experience in the study was positive, the questions were understandable, their responses to questions were generally accurate, and the surveys were minimally burdensome. The study procedures did not appear to be iatrogenic; suicide attempts and rehospitalizations were not study related and occurred at a rate comparable to other adolescents at the recruitment site. Adolescents’ clinicians reported that the study was somewhat positive and minimally burdensome for them, and somewhat positive for their patients and families. Conclusions: This study demonstrated that intensive EMA designs are feasible and acceptable among high-risk suicidal youth following acute psychiatric care. Specific procedures are provided for keeping adolescents safe during intensive EMA studies, including detailed information about the risk and safety monitoring plan.

Commentary: Ecology momentary assessment as a tool for understanding dynamic patterns in child and adolescent health and development – reflections on Russell and Gajos (2020)

Ecological momentary assessment (EMA) has served as a methodological tool across subdisciplines in psychology, shedding light on family, personality, and affective processes, and physical and mental health. In their review, Russell and Gajos demonstrate how EMA can overcome several limitations of traditional methods in developmental psychopathology to answer questions about mental and behavioral health in youth. They also provide thoughtful future directions on integrating sensor technology, advancing modeling techniques for temporally dense data, and employing EMA for delivering interventions. This commentary similarly advocates for the use of EMA but extends Russell and Gajos's review by emphasizing EMA's utility for understanding and revealing dynamic changes and processes along micro timescales that have relevance for youth's health and development. We discuss how EMA can be especially fruitful for advancing theory and practice when administered in bursts and when combined with traditional assessments and longer-term longitudinal designs. Because such studies are resource-intensive, we also consider how extant EMA studies can be leveraged and subjected to meta- and mega-analytic techniques to inform theories and future EMA designs. We conclude that EMA is a promising tool for elucidating dynamic fluctuations in experiences and intra- and interpersonal processes that contribute to child and adolescent development and risk.

Daily meaning salience and physical activity in previously inactive exercise initiates.

Individuals living with more experienced meaning, or meaning salience, may be more likely to engage in health behaviors including physical activity. This study examined daily meaning salience and physical activity in previously inactive exercise initiates. Inactive adults (N = 80, 78% female, Mage = 43 years, SD = 11 years) intending to increase physical activity participated in a daily diary study. At baseline, participants completed self-report questionnaires of demographics, global meaning and purpose, depressive symptoms, and motivation. Fitness center attendance was extracted from the member database. Participants self-reported meaning salience, positive mood, negative mood, and physical activity (duration in minutes; intensity in ratings of perceived exertion) daily for the first 28 days. Multilevel and multiple regression analyses were used. Multilevel models revealed that controlling for demographics, mood, and motivation, for every standard deviation increase in meaning salience, participants were 44% more likely to visit the fitness center, odds ratio (OR) = 1.44, 95% CI [1.24,1.68], p < .001. Further, increases in meaning salience above average were positively related to physical activity duration, β = .19, p < .001, and intensity, β = .13, p < .001. Global meaning and purpose were not significantly related to physical activity duration, physical activity intensity, or fitness center visits over the 28 days. Results suggest that increased meaning salience, but not global meaning or purpose, is associated with physical activity participation in previously inactive exercise initiates, and may be a proximal predictor of physical activity behavior. Future research should use ecological momentary assessment (EMA) designs to examine the relationship within days and over longer intervals. (PsycINFO Database Record

Decentering Attenuates the Associations of Negative Affect and Positive Affect With Psychopathology

Theory on decentering—an observer perspective on one’s ongoing internal experiences—suggests that decentering may be a protective factor against extreme affective states in predicting psychopathology. The current studies were the first to empirically test this, using multiple measures of decentering to capture two distinct components. Across three student samples and two clinical samples, we investigated whether trait decentering moderated the relationship of negative affect and positive affect with a variety of internalizing symptoms, as well as with narcissism, mania, and anhedonia. Greater decentering attenuated the associations of negative affect with dysphoria and panic symptoms, in both cross-sectional (Study 1) and ecological momentary assessment (Study 2) designs. Exploratory analyses in a single sample revealed that positive affect interacted with decentering to predict anhedonia and narcissism symptoms. Implications are discussed for understanding the effects of decentering on psychopathology and refining interventions, as well as the conceptualization and assessment of decentering.

Repeated self-evaluations may involve familiarization: An exploratory study related to Ecological Momentary Assessment designs in patients with major depressive disorder.

A growing body of research in clinical psychology is now relying on Ecological Momentary Assessment (EMA). EMA is fitted to investigate fluctuating processes and as such, it is of particular interest in a clinical context in which patients are often characterized by fluctuating behaviors and affective states or symptoms. EMA typically involves frequent self-evaluations over long periods, which may influence patient response. The present study aimed to determine whether EMA follow-ups could influence the participants' self-evaluations over time. The sample comprised 24 outpatients suffering from a Major Depressive Disorder (15 women, age = 51.4 ± 9.6). This study relied on an EMA protocol involving self-evaluations of seven depressive symptoms twice a day over 5 months. Patients did not show any clinical improvement following the clinical screening and the level of depressive symptoms during the follow-up. As a novel finding, significant moderate to large effects were observed for decreased variability and instability of psychological states over time. The main difference in temporal properties of psychological states was found after the first two weeks of the follow-up. This study characterized early changes in patients' self-evaluations, suggesting the idea of a valuable familiarization period during the first two weeks of an EMA follow-up.

Five Facets of Mindfulness and Psychological Health: Evaluating a Psychological Model of the Mechanisms of Mindfulness.

There has been an increasing focus on determining the psychological mechanisms underlying the broad effects of mindfulness on psychological health. Mindfulness has been posited to be related to the construct of reperceiving or decentering, defined as a shift in perspective associated with decreased attachment to one's thoughts and emotions. Decentering is proposed to be a meta-mechanism that mobilizes four psychological mechanisms (cognitive flexibility, values clarification, self-regulation, and exposure), which in turn are associated with positive health outcomes. Despite preliminary support for this model, extant studies testing this model have not examined distinct facets of mindfulness. The present study used a multidimensional measure of mindfulness to examine whether this model could account for the associations between ive facets of mindfulness and psychological symptoms (depressive symptoms, stress, anxiety symptoms, alcohol-related problems) in a sample of college students (N = 944). Our findings partially support this model. We found significant double-mediated associations in the expected directions for all outcomes (stress, anxiety symptoms, and depressive symptoms) except alcohol-related problems, and for each of the facets of mindfulness except observing. However, decentering and the specific mechanisms did not fully mediate the associations among mindfulness facets and psychological health outcomes. Experimental and ecological momentary assessment designs are needed to understand the psychological processes that account for the beneficial effects of mindfulness.

Conceptualizing and Estimating Process Speed in Studies Employing Ecological Momentary Assessment Designs: A Multilevel Variance Decomposition Approach

Researchers have been making use of ecological momentary assessment (EMA) and other study designs that sample feelings and behaviors in real time and in naturalistic settings to study temporal dynamics and contextual factors of a wide variety of psychological, physiological, and behavioral processes. As EMA designs become more widespread, questions are arising about the frequency of data sampling, with direct implications for participants' burden and researchers' ability to capture and study dynamic processes. Traditionally, spectral analytic techniques are used for time series data to identify process speed. However, the nature of EMA data, often collected with fewer than 100 measurements per person, sampled at randomly spaced intervals, and replete with planned and unplanned missingness, precludes application of traditional spectral analytic techniques. Building on principles of variance partitioning used in the generalizability theory of measurement and spectral analysis, we illustrate the utility of multilevel variance decompositions for isolating process speed in EMA-type data. Simulation and empirical data from a smoking-cessation study are used to demonstrate the method and to evaluate the process speed of smoking urges and quitting self-efficacy. Results of the multilevel variance decomposition approach can inform process-oriented theory and future EMA study designs.

Ecological momentary assessment (EMA) in studies of substance use.

Ecological momentary assessment (EMA) is particularly suitable for studying substance use, because use is episodic and thought to be related to mood and context. This article reviews EMA methods in substance use research, focusing on tobacco and alcohol use and relapse, where EMA has been most applied. Common EMA designs combine event-based reports of substance use with time-based assessments. Approaches to data organization and analysis have been very diverse, particularly regarding their treatment of time. Compliance with signaled assessments is often high. Compliance with recording of substance use appears good but is harder to validate. Treatment applications of EMA are emerging. EMA captures substance use patterns not measured by questionnaires or retrospective data and holds promise for substance use research.

Ambulatory Assessment

Ambulatory Assessment

Ecological Momentary Assessment

Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on the dynamics of behavior in real-world settings.