Ecological Momentary Assessment Reports Research Articles

Alcohol use in daily life: Examining the role of trait and state impulsivity facets.

Using ecological momentary assessment (EMA) methods we aimed to investigate the influence of trait and state (momentary) impulsivity on alcohol use behaviors in daily life. Facets of the UPPS trait model of impulsivity (Whiteside & Lynam, 2001) have been found to differentially relate to alcohol-related outcomes and behaviors in cross-sectional and longitudinal studies. The present work expands on this by assessing UPPS facets in daily life and examining the contributions of trait and state impulsivity facets to daily life drinking behavior. Forty-nine participants were prompted at least 6 times per day for 21 days. A total of 4,548 collected EMA reports were included in analyses. Multilevel models were computed predicting daily life alcohol use behaviors from state and trait impulsivity facets and relevant covariates. Individual facets of momentary impulsivity differentially related to alcohol outcomes, such that (lack of) premeditation and, to a lesser extent, sensation seeking showed unique patterns of association with drinking and drinking quantity. Only trait levels of (lack of) premeditation were related to drinking behavior in daily life; no other trait UPPS scale significantly related to alcohol use. These results highlight state difficulties with premeditation as particularly relevant to drinking behavior in daily life. Our results also support the incremental validity of state impulsivity facets over trait level measures in relation to drinking behavior in daily life. These findings offer important insight into the phenomenology of daily life alcohol use and highlight possible avenues for intervention and prevention efforts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Ecological momentary assessment as a measurement tool in depression trials

We used ecological momentary assessment (EMA) to track symptoms during a clinical trial. Thirty-six participants with major depressive disorder (MDD) and MADRS scores ≥20 were enrolled in a nonrandomized 6-week open-label trial of commercially available antidepressants. Twice daily, a mobile device prompted participants to self-report the 6 items of the HamD6 sub-scale derived from the Hamilton rating scale for depression (HamD17). Morning EMA reports asked “how do you feel now” whereas evening reports gathered a full-day impression. Clinicians who were blinded to the EMA data rated the MADRS, HamD17 and HamD6 at screen, baseline and weeks 2,4, and 6. Hierarchical linear modeling (HLM) examined the course of the EMA assessments and convergence between EMA scores and clinician ratings. HLM analyses revealed strong correlations between AM and PM EMA derived HamD6 scores and revealed significant improvements over time. EMA improvements were significantly correlated with the clinician rated HamD6 scores at endpoint and predicted clinician rated HamD6 score changes from baseline to endpoint (p < .001). There was a large correlation between EMA and clinician derived HamD6 scores at each in-person assessment after baseline. Treatment response defined by EMA matched the clinician rated HamD6 treatment responses in 33 of 36 cases (91.7%). EMA derived symptom scores appear to be efficient and valid measures to track daily symptomatic change in clinical trials and may provide more accurate measures of symptom severity than the episodic “snapshots” that are currently used as clinical outcomes. These findings support further investigation of EMA for assessment in clinical trials.

Ecological momentary facial emotion recognition in psychotic disorders.

Cognitive tasks delivered during ecological momentary assessment (EMA) may elucidate the short-term dynamics and contextual influences on cognition and judgements of performance. This paper provides initial validation of a smartphone task of facial emotion recognition in serious mental illness. A total of 86 participants with psychotic disorders (non-affective and affective psychosis), aged 19-65, were administered in-lab 'gold standard' affect recognition, neurocognition, and symptom assessments. They subsequently completed 10 days of the mobile facial emotion recognition task, assessing both accuracy and self-assessed performance, along with concurrent EMA of psychotic symptoms and mood. Validation focused on task adherence and predictors of adherence, gold standard convergent validity, and symptom and diagnostic group variation. The mean rate of adherence to the task was 79%; no demographic or clinical variables predicted adherence. Convergent validity was observed with in-lab measures of facial emotion recognition, and no practice effects were observed on the mobile facial emotion recognition task. EMA reports of more severe voices, sadness, and paranoia were associated with worse performance, whereas mood more strongly associated with self-assessed performance. The mobile facial emotion recognition task was tolerated and demonstrated convergent validity with in-lab measures of the same construct. Social cognitive performance, and biased judgements previously shown to predict function, can be evaluated in real-time in naturalistic environments.

Prevalence of Insomnia Symptoms and Need for an Intervention Among Direct-Care Workers in Long-Term Care

This study examined the prevalence of insomnia symptoms among direct-care workers at an assisted-living community and their perceived need for a sleep intervention. Thirty-five participants reported their main sleep-related concerns, willingness to participate in a sleep intervention, and preferred delivery forms/content of the intervention. They also reported nightly sleep characteristics via ecological momentary assessment (EMA) for 2 weeks. 80% reported any sleep-related concern; insomnia-related concern was most prevalent (57%). This was also evident in their EMA reports of waking up in the middle of the night or early morning for 72% of the days. Most (66%) expressed interest in participating in a sleep intervention either online or in group sessions. Mindfulness strategies were most preferred, followed by cognitive-behavioral therapy, and sleep hygiene education. The high prevalence of insomnia symptoms in direct-care workers needs to be addressed by future interventions for their well-being as well as for the quality of care.

Substance Use, Risky Sex, and Peer Interactions Predict Sexual Assault Among College Women: An Ecological Momentary Assessment (EMA) Study

Sexual assault is an unfortunately common experience among women in college campuses. This study used ecological momentary assessment (EMA) to gain a better understanding of the contextual determinants of sexual assault among college women. EMA reports inquired about sexual assault experiences, risky sex (sex without a condom and regretted hookups), and substance use (alcohol and cannabis use), as well as what activities participants were engaged in (e.g., pregaming, drinking with peers, and drinking with a casual sexual partner), and whether they experienced peer pressure to engage in casual sex. Participants were 103 freshman undergraduate women (18-24 years old) at a Southwestern university in the United States, who were unmarried, interested in dating opposite-sex partners, engaged in binge drinking (defined as having 3 or more drinks on one occasion) in the past month, and reported at least one experience of sexual intercourse in their lifetime. Participants completed reports (one random and two time-contingent) via EMA three times a day over a 42-day period. Compliance in completing EMA reports was good (84.2% of prompted reports were completed), and time-to-completion of reports once signaled was acceptable (mean = 26 minutes, median = 5.75 minutes). During the 42 days, 40 women (38.8%) reported 75 occasions of sexual assault. The odds of experiencing sexual assault were significantly greater during occasions of regretted hookups and unprotected sex. Additionally, drinking with peers and peer pressure to engage in casual sex were each associated significantly with occasions of sexual assault. Reducing risk for sexual assault among undergraduate women may be possible by targeting these behaviors and contextual features in near real-time via momentary intervention.

Interstitial glucose and subsequent affective and physical feeling states: A pilot study combining continuous glucose monitoring and ecological momentary assessment in adolescents

ObjectiveCirculating glucose may relate to affective and physical feeling states reflective of emotional disorder symptoms. No prior studies have investigated within-day associations between glucose and subsequent affective and physical feeling states (positive affect, negative affect, and fatigue) as they occur naturally among healthy adolescents; this pilot study assessed these associations by combining data collected from ecological momentary assessment (EMA) and continuous glucose monitors (CGM). MethodsParticipants (N = 15, mean age = 13.1[±1.0] years, 66.7% female, 40.0% Hispanic, 66.7% healthy weight) wore a CGM for 7–14 days. Simultaneously, participants reported on their current positive affect, negative affect, and fatigue randomly during specified windows up to 7 times daily via EMA. CGM-measured mean interstitial glucose was calculated during the time windows (mean minutes = 122.5[±47.3]) leading up to each EMA prompt. Multilevel models assessed within-subject (WS) associations between mean interstitial glucose since the previous EMA prompt and EMA-reported affective and physical feeling states at the current prompt. ResultsParticipants provided 532 interstitial glucose-matched EMA reports of affective and physical feeling states. During intervals when interstitial glucose was higher than one's usual, higher positive affect (WS β = 0.01, p < .0001, f2 = 0.02) and lower fatigue (WS β = −0.01, p < .0001, f2 = 0.09) were subsequently reported. Interstitial glucose was unrelated to negative affect (WS β = −0.002, p = .10, f2 = 0.01). Associations were weakened, but remained significant following further adjustment for time of day. ConclusionsThough effect sizes were small, within-person variations in interstitial glucose may relate to subsequent affective and physical feeling states among healthy youth. Investigations using similar methodologies in larger, more diverse samples are warranted.

Mathematically Modeling Anhedonia in Schizophrenia: A Stochastic Dynamical Systems Approach.

Anhedonia, traditionally defined as a diminished capacity for pleasure, is a core symptom of schizophrenia (SZ). However, modern empirical evidence indicates that hedonic capacity may be intact in SZ and anhedonia may be better conceptualized as an abnormality in the temporal dynamics of emotion. To test this theory, the current study used ecological momentary assessment (EMA) to examine whether abnormalities in one aspect of the temporal dynamics of emotion, sustained reward responsiveness, were associated with anhedonia. Two experiments were conducted in outpatients diagnosed with SZ (n = 28; n = 102) and healthy controls (n = 28; n = 71) who completed EMA reports of emotional experience at multiple time points in the day over the course of several days. Markov chain analyses were applied to the EMA data to evaluate stochastic dynamic changes in emotional states to determine processes underlying failures in sustained reward responsiveness. In both studies, Markov models indicated that SZ had deficits in the ability to sustain positive emotion over time, which resulted from failures in augmentation (ie, the ability to maintain or increase the intensity of positive emotion from time t to t+1) and diminution (ie, when emotions at time t+1 are opposite in valence from emotions at time t, resulting in a decrease in the intensity of positive emotion over time). Furthermore, in both studies, augmentation deficits were associated with anhedonia. These computational findings clarify how abnormalities in the temporal dynamics of emotion contribute to anhedonia.

GPS mobility as a digital biomarker of negative symptoms in schizophrenia: a case control study

Mobility is an important correlate of physical, cognitive, and mental health in chronic illness, and can be measured passively with mobile phone global positional satellite (GPS) sensors. To date, GPS data have been reported in a few studies of schizophrenia, yet it is unclear whether these data correlate with concurrent momentary reports of location, vary by people with schizophrenia and healthy comparison subjects, or associate with symptom clusters in schizophrenia. A total of 142 participants with schizophrenia (n = 86) or healthy comparison subjects (n = 56) completed 7 days of ecological momentary assessment (EMA) reports of location and behavior, and simultaneous GPS locations were tracked every five minutes. We found that GPS-derived indicators of average distance travelled overall and distance from home, as well as percent of GPS samples at home were highly correlated with EMA reports of location at the day- and week-averaged level. GPS-based mobility indicators were lower in schizophrenia with medium to large effect sizes. Less GPS mobility was related to greater negative symptom severity, particularly diminished motivation, whereas greater GPS mobility was weakly associated with more community functioning. Neurocognition, depression, and positive symptoms were not associated with mobility indicators. Therefore, passive GPS sensing could provide a low-burden proxy measure of important outcomes in schizophrenia, including negative symptoms and possibly of functioning. As such, passive GPS sensing could be used for monitoring and timely interventions for negative symptoms in young persons at high risk for schizophrenia.

Effects of a Smartphone-Based Approach-Avoidance Intervention on Chocolate Craving and Consumption: Randomized Controlled Trial.

BackgroundRepeatedly pushing high-calorie food stimuli away based on joystick movements has been found to reduce approach biases toward these stimuli. Some studies also found that such avoidance training reduced consumption of high-calorie foods.ObjectiveThis study aimed to test effects of a smartphone-based approach-avoidance intervention on chocolate craving and consumption, to make such interventions suitable for daily use.MethodsWithin a 10-day period, regular chocolate eaters (n=105, 86% female) performed five sessions during which they continuously avoided (ie, swiped upward) chocolate stimuli (experimental group, n=35), performed five sessions during which they approached and avoided chocolate stimuli equally often (placebo control group, n=35), or did not perform any training sessions (inactive control group, n=35). Training effects were measured during laboratory sessions before and after the intervention period and further continuously through daily ecological momentary assessment.ResultsSelf-reported chocolate craving and consumption as well as body fat mass significantly decreased from pre- to postmeasurement across all groups. Ecological momentary assessment reports evidenced no differences in chocolate craving and consumption between intervention days and rest days as a function of the group.ConclusionsA smartphone-based approach-avoidance training did not affect eating-related and anthropometric measures over and above measurement-based changes in this study. Future controlled studies need to examine whether other techniques of modifying food approach tendencies show an add-on benefit over conventional, monitoring-based intervention effects.Trial RegistrationAsPredicted 8203; https://aspredicted.org/pt9df.pdf.

When Hindsight Is Not 20/20: Ecological Momentary Assessment of PTSD Symptoms Versus Retrospective Report.

Assessment of posttraumatic stress disorder (PTSD) has relied almost exclusively on retrospective memory of symptoms, sometimes over long intervals. This approach creates potential for recall bias and obscures the extent to which symptoms fluctuate. The aim of the present study was to examine the discrepancy between retrospective self-reporting of PTSD symptoms and ecological momentary assessment (EMA), which captures symptoms closer to when they occur. The study also sought to estimate the degree to which PTSD symptoms vary or are stable in the short-term. World Trade Center responders (N = 202) oversampled for current PTSD (19.3% met criteria in past month) were assessed three times a day for 7 consecutive days. Retrospective assessment of past week symptoms at the end of the reporting period were compared with daily EMA reports. There was correspondence between two approaches, but retrospective reports most closely reflected symptom severity on the worst day of the reporting period rather than average severity across the week. Symptoms varied significantly, even within the span of hours. Findings support intervention research efforts focused on exploiting significant, short-term variability of PTSD symptoms, and suggest that traditional assessments most reflect the worst day of symptoms over a given period of recall.

Risk-Taking Propensity, Affect, and Alcohol Craving in Adolescents’ Daily Lives

Background: Alcohol craving is common among adolescents, stronger among those with more alcohol-related problems, and predicts drinking levels in their daily lives. Yet, the conditions that predict momentary changes in craving in real time among adolescents remain unclear. Objectives: This study examined the interactive effects of momentary risk-taking propensity and affect on adolescents’ alcohol craving by leveraging ecological momentary assessment (EMA) methods. Methods: Participants were 29 adolescents ages 15–19 years (55% female; 69% White; 10% Black; 17% Hispanic); 45% met criteria for alcohol dependence. Following a laboratory session that captured self-report and behavioral assessments, including the well-established Balloon Analog Risk Task (BART), participants completed multiple daily assessments of alcohol craving, positive and negative affect, and risk propensity for approximately one week. Momentary risk propensity was captured in real-world settings via an EMA behavioral task (“Balloon Game”). Results: Mixed-effects models with EMA reports (Level 1) nested within participants (Level 2) revealed the majority (74%) of variability in “Balloon Game” performance was due to within-person, momentary, fluctuations. Greater momentary positive affect predicted increased alcohol craving, but only when participants exhibited heightened risk-taking propensity. Negative affect did not influence the relation between momentary risk-taking and craving. Conclusions/Importance: Momentary fluctuations in positive affect predicted acute increases in craving but only in moments when adolescents demonstrated higher levels of risk-taking propensity, as captured with an EMA-delivered behavioral task. Momentary risk-taking assessments offer new avenues to substantiate dominant theories on the driving mechanisms of craving and alcohol use among adolescents.

An ecological momentary assessment study examining posttraumatic stress disorder symptoms, prenatal bonding, and substance use among pregnant women

BackgroundSubstance use disorder (SUD) during pregnancy requires efficacious interventions based on understanding the ebb and flow of risk and protective factors for substance use across time. To assess how these fluctuations are associated temporally with substance use, we used ecological momentary assessment (EMA) to evaluate substance use risk (posttraumatic stress disorder [PTSD] symptoms) and protective (prenatal fetal bonding) factors and their associations with prenatal substance use recorded in real time. MethodsPregnant women in SUD treatment (N = 33) with prior trauma exposure received smartphones with an EMA application that queried them thrice daily for 28 days about PTSD symptoms, prenatal bonding, and substance use. ResultsNearly all (N = 32) provided EMA data resulting in 2049 EMA reports (74% compliance). Most participants reported tobacco (72%), alcohol (22%), heroin (41%), and/or other illicit drug (6%–31%) use at least once via EMA. There were moderate associations (average β = 0.23) between greater daily peak PTSD symptoms and substance use with significant effects on illicit drug (β = 0.37), cannabis (β = 0.35) and cigarette use (β = 0.24). Prenatal bonding subscales were modestly associated with substance use, with daily intensity of attachment low point associated with lower heroin (β=-0.34), but higher alcohol (β = 0.24) use. Quality of attachment low point was associated with higher cigarette use (β = 0.06). ConclusionsDespite the SUD severity and social instability of this sample, we observed high rates of compliance. We found preliminary support suggesting daily PTSD symptoms as a risk factor and less consistent support for prenatal bonding as a protective factor for prenatal substance use.

Association Between Self-Reported and Objective Activity Levels by Demographic Factors: Ecological Momentary Assessment Study in Children.

BackgroundTo address the limitations of the retrospective self-reports of activity, such as its susceptibility to recall bias, researchers have shifted toward collecting real-time activity data on mobile devices via ecological momentary assessment (EMA). Although EMA is becoming increasingly common, it is not known how EMA self-reports of physical activity and sedentary behaviors relate to the objective measures of activity or whether there are factors that may influence the strength of association between these two measures. Understanding the relationship between EMA and accelerometry can optimize future instrument selection in studies assessing activity and health outcomes.ObjectiveThe aim of this study was to examine the associations between EMA-reported sports or exercise using the accelerometer-measured moderate-to-vigorous physical activity (MVPA) and EMA-reported TV, videos, or video games with the accelerometer-measured sedentary time (ST) in children during matched 2-h windows and test potential moderators.MethodsChildren (N=192; mean age 9.6 years; 94/192, 49.0% male; 104/192, 54.2% Hispanic; and 73/192, 38.0% overweight or obese) wore an accelerometer and completed up to 7 EMA prompts per day for 8 days during nonschool time, reporting on past 2-h sports or exercise and TV, videos, or video games. Multilevel models were used to assess the relationship between the accelerometer-measured ST and EMA-reported TV, videos, or video games. Given the zero-inflated distribution of MVPA, 2-part models were used assess the relationship between the accelerometer-measured MVPA and EMA-reported sports or exercise.ResultsEMA-reported TV, videos, or video games were associated with a greater accelerometer-measured ST (beta=7.3, 95% CI 5.5 to 9.0, P<.001). This relationship was stronger in boys (beta=9.9, 95% CI 7.2 to 12.6, P<.001) than that in girls (beta=4.9, 95% CI 2.6 to 7.2, P≤.001). EMA-reported sports or exercise was associated with a greater accelerometer-measured MVPA (zero portion P<.001; positive portion P<.001). This relationship was stronger on weekends, in older children, and in non-Hispanic children (zero portion all P values<.001; positive portion all P values<.001).ConclusionsEMA reports highly relate to accelerometer measures. However, the differences in the strength of association depending on various demographic characteristics suggest that future research should use both EMA and accelerometers to measure activity to collect complementary activity data.

An ecological momentary assessment evaluation of emotion regulation abnormalities in schizophrenia.

Prior studies using self-report questionnaires and laboratory-based methods suggest that schizophrenia is characterized by abnormalities in emotion regulation (i.e. using strategies to increase or decrease the frequency, duration, or intensity of negative emotion). However, it is unclear whether these abnormalities reflect poor emotion regulation effort or adequate effort, but limited effectiveness. It is also unclear whether dysfunction results primarily from one of the three stages of the emotion regulation process: identification, selection, or implementation. The current study used ecological momentary assessment (EMA) to address these questions in the context of everyday activities. Participants included 28 outpatients diagnosed with schizophrenia (SZ) and 28 demographically matched healthy controls (CN) who completed 6 days of EMA reports of in-the-moment emotional experience, emotion regulation strategy use, and context. Results indicated that SZ demonstrated adequate emotion regulation effort, but poor effectiveness. Abnormalities were observed at each of the three stages of the emotion regulation process. At the identification stage, SZ initiated emotion regulation efforts at a lower threshold of negative emotion intensity. At the selection stage, SZ selected more strategies than CN and strategies attempted were less contextually appropriate. At the implementation stage, moderate to high levels of effort were ineffective at decreasing negative emotion. Findings suggest that although SZ attempt to control their emotions using various strategies, often applying more effort than CN, these efforts are unsuccessful; emotion regulation abnormalities may result from difficulties at the identification, selection, and implementation stages.

Exposure to workplace smoking bans and continuity of daily smoking patterns on workdays and weekends

IntroductionIndividuals may compensate for workplace smoking bans by smoking more before or after work, or escaping bans to smoke, but no studies have conducted a detailed, quantitative analysis of such compensatory behaviors using real-time data. Methods124 daily smokers documented smoking occasions over 3weeks using ecological momentary assessment (EMA), and provided information on real-world exposure to smoking restrictions and type of workplace smoking policy (full, partial, or no bans). Mixed modeling and generalized estimating equations assessed effects of time of day, weekday (vs weekend), and workplace policy on mean cigarettes per hour (CPH) and reports of changing location to smoke. ResultsIndividuals were most likely to change locations to smoke during business hours, regardless of work policy, and frequency of EMA reports of restrictions at work was associated with increased likelihood of changing locations to smoke (OR=1.11, 95% CI 1.05–1.16; p<0.0001). Workplace smoking policy, time block, and weekday/weekend interacted to predict CPH (p<0.01), such that individuals with partial work bans –but not those with full bans - smoked more at night (9pm – bed) on weekdays compared to weekends. ConclusionsThere was little evidence that full bans interfered with subjects' smoking during business hours across weekdays and weekends. Smokers largely compensate for exposure to workplace smoking bans by escaping restrictions during business hours. Better understanding the effects of smoking bans on smoking behavior may help to improve their effectiveness and yield insights into determinants of smoking in more restrictive environments.

Momentary factors during marijuana use as predictors of lapse during attempted abstinence in young adults

IntroductionYoung adults using marijuana heavily often try multiple times to quit on their own. We sought to identify momentary experiences during marijuana use that could aid in predicting lapse when young adults subsequently attempt abstinence. MethodsYoung adults (N=34) age 18–25 using marijuana ≥5days/week and planning to quit completed a survey of sociodemographic characteristics, substance use, marijuana expectancies, use motives, perceived social support, and confidence to abstain. They completed ecological momentary assessment (EMA) smartphone reports several times/day for two weeks prior to, then during two weeks of attempted abstinence. Use period EMA reports assessed affect, craving, accessibility, situational permissibility, use, and motivation to abstain. Baseline survey and EMA data were examined in relation to subsequent lapse during attempted abstinence. ResultsNearly 3 in 4 participants (73.5%) reported lapsing during attempted abstinence from marijuana. On bivariate analyses, lower baseline dependence severity score, negative effect expectancies, perceived family support, and confidence to abstain were each associated with lapse. Of the use period EMA variables, greater percent of days with marijuana use, reports of easy accessibility, and reports of situational permissibility were each associated with lapse. Modeled together, negative effect expectancies, perceived family support, confidence to abstain, and situational permissibility during use were highly accurate in predicting lapse during attempted abstinence. ConclusionsMomentary factors may add to conventionally-surveyed characteristics to enhance prediction of lapse during attempted abstinence among young adults with heavy marijuana use.Momentary assessment prior to a quit attempt may thus enable more effective personalized approaches to preventing lapse.

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.

Family Assessment Device: Real-world validity in urban families of children with asthma.

Ecological momentary assessment (EMA) was used to further validate the real-world predictability of the Family Assessment Device (FAD) among low income, racial and ethnic minority, urban families of children (7-12 years) with asthma. Caregivers completed self-report measures at baseline, as well as daily assessments of family functioning for 2 weeks through EMA delivered via smartphone. Concurrent validity was established with measures of caregiver perceived stress and positive and negative affect at baseline. Better family functioning at baseline was associated with EMA reports of families getting along better and of being better able to balance multiple family needs, including child asthma management. Consistent with previous literature, findings suggest the FAD is an ecologically valid measure for use with urban families of children with asthma. Researchers and clinicians may be confident that assessments of family functioning in research and clinical settings are predictive of what may be happening in the family's everyday life. (PsycINFO Database Record

187. Modeling Anhedonia in Schizophrenia: A Stochastic Dynamical Systems Approach

Background: Anhedonia, traditionally defined as a diminished capacity to experience pleasure, has long been considered a core feature of schizophrenia. However, modern evidence indicates that anhedonia is better considered a reduction in the frequency of approach behavior than diminished intensity of pleasure when engaged in activities. The current study used Ecological Momentary Assessment (EMA) to examine whether schizophrenia patients display abnormalities in the temporal dynamics of emotion that prevent fully intense in-the-moment positive emotions from translating into approach behavior. Methods: Participants included 28 outpatients with schizophrenia and 28 healthy controls who completed prospective, retrospective, and in-the moment EMA reports of emotional experience at multiple time points in the day, over the course of 6 days. Mathematical models, including network analysis and Markov chain analysis, were applied to the EMA data to evaluate stochastic dynamic changes in emotional states to determine mechanisms underlying failures to sustain positive emotion across time. Results: Results indicated no group differences for intensity of in-the-moment, retrospective, or prospective reports of positive emotion. However, mathematical models indicated that SZ had deficits in the ability to sustain positive emotion over time, which resulted from failures in augmentation (i.e., the ability to maintain or increase the intensity of positive emotion from time t to t+1) and blunting (i.e., when emotions at time t+1 are opposite in valence from emotions at time t, resulting in a decrease in the intensity of positive emotion over time) that predicted reductions in approach behavior. Conclusion: Findings suggest that abnormalities in the temporal dynamics of emotion are central features of schizophrenia that predict reduced approach behavior, providing a novel mechanistic account of anhedonia as it occurs in the real world.

SU109. Trying but not Succeeding: An Ecological Momentary Assessment Evaluation of Emotion Regulation in Schizophrenia

Abstract Background: Prior studies using self-report questionnaires and laboratory-based methods suggest that schizophrenia (SZ) is characterized by abnormalities in emotion regulation (ie, using strategies to increase or decrease the frequency, duration, or intensity of negative emotion). However, it is unclear whether these abnormalities reflect poor emotion regulation effort or adequate effort, but limited effectiveness. It is also unclear whether dysfunction results primarily from one of the 3 stages of the emotion regulation process: identification, selection, or implementation. Methods: The current study used Ecological Momentary Assessment (EMA) to address these questions in the context of everyday activities. Participants included 28 outpatients diagnosed with SZ and 28 demographically matched healthy controls (CN) who completed 6 days of EMA reports of in-the-moment emotional experience, emotion regulation strategy use, and context. Results: Results indicated that SZ patients demonstrated adequate emotion regulation effort, but poor effectiveness. Abnormalities were observed at each of the 3 stages of the emotion regulation process. At the identification stage, SZ initiated emotion regulation efforts at a lower threshold of negative emotion. At the selection stage, SZ selected more strategies than CN and strategies attempted were less contextually appropriate. At the implementation stage, moderate to high levels of effort were ineffective at decreasing negative emotion. Conclusion: Findings suggest that although SZ attempts to control their emotions using various strategies, often applying more effort than CN, these efforts are unsuccessful; emotion regulation failures may result from abnormalities at the identification, selection, and implementation stages.