Ecological Momentary Intervention Research Articles

A Pilot Implementation-Effectiveness Trial of a Single-Session Telehealth Workshop and Smartphone-Based Cognitive Behavioral Intervention for Managing Emotions Among College Students

The number of college students who need mental health treatment outpaces the resources available to counseling centers to provide these needed services, presenting a need for low-cost, scalable interventions for college populations. We conducted a pilot implementation-effectiveness trial of a scalable treatment package that consisted of a single (telehealth) workshop plus a companion app that provided ecological momentary intervention. Participants (n = 177) received a workshop provided by counseling center staff and trainees. We were interested in (1) engagement with the app, (2) acceptability of the treatment package, and (3) initial effectiveness of the treatment package. Regarding engagement with the app, we found that participants preferred two reminder prompts per day and identified two key breakpoints when engagement declined significantly: at day 15, when just over half of the sample practiced a skill on the app at least once during the day and at day 41, when just over one third of people practiced a skill on the app each day. Regarding acceptability of the treatment package, students generally reported positive attitudes about the single-session workshop and app, but also noted that the content and assessments in the app needed to be more dynamic to improve how engaging it is. Regarding effectiveness, we found that about 75% of the sample experienced a significant reduction in negative affect from pre- to post-ecological momentary intervention. Moreover, there were significant pre- to post-study decreases in experiential avoidance and symptoms of anxiety and depression and increases in self-efficacy for managing negative emotions. The results of this study are promising in terms of providing initial support for this novel treatment package and provide useful information for researchers planning to develop and test similar interventions.

Efficacy of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Results from the Multi-Center INTERACT Randomized Controlled Trial

Introduction/Objective: This study aimed to investigate efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in addition to treatment as usual (TAU) for psychotic distress, in comparison to TAU. Methods: Individuals aged 15–65 years with clinically established ultra-high risk or first episode of psychosis were randomly assigned to TAU or ACT-DL+TAU. ACT-DL+TAU consisted of 8 ACT-sessions augmented with an EMI-app. The primary outcome was psychotic distress assessed with the Comprehensive Assessment scale of At Risk Mental State (CAARMS) at post-intervention and 6- and 12-month follow-up. Secondary outcomes were functioning, symptom severity, and momentary psychotic distress. We performed multivariate mixed models according to intent-to-treat principles. Results: Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148 were randomized to ACT-DL+TAU (n = 71) or TAU (n = 77). One hundred and fifteen (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of greater reduction in the primary outcome measure CAARMS distress in ACT-DL+TAU compared to TAU (χ²(3) = 2.36; p = 0.50). However, out of the tested secondary outcomes, global functioning (χ²(3) = 9.05; p = 0.033), and negative symptoms (χ²(3) = 19.91; p<0.001) improved in ACT-DL+TAU compared to TAU, as did momentary psychotic distress (χ²(3) = 21.56; p < 0.001). Conclusions: INTERACT did not support a significant effect of ACT-DL over TAU on the primary outcome measure of psychotic distress as assessed with the CAARMS. Although significant improvements were found for some secondary outcome measures, further replication studies are needed to confirm the strength and specificity of these effects.

Ecological momentary intervention to enhance emotion regulation in healthcare workers via smartphone: a randomized controlled trial protocol

BackgroundCUIDA-TE is an APP that offers transdiagnostic cognitive behavioral therapy focused on enhancing emotion regulation. As a novelty, it incorporates ecological momentary interventions (EMI), which can provide psychological support in real time, when suffering arises. The main goal of the study is to evaluate the efficacy of CUIDA-TE to improve emotion regulation in healthcare workers, a population that has been particularly emotionally impacted by the COVID-19 pandemic.MethodsIn this three-arm, randomized controlled trial (RCT) the study sample will be composed of a minimum of 174 healthcare workers. They will be randomly assigned to a 2-month EMI group (CUIDA-TE APP, n ≥ 58), a 2-month ecological momentary assessment (EMA) only group (MONITOR EMOCIONAL APP, n ≥ 58), or a wait-list control group (no daily monitoring nor intervention, n ≥ 58). CUIDA-TE will provide EMI if EMA reveals emotional problems, poor sleep quality/quantity, burnout, stress, or low perceived self-efficacy when regulating emotions. Depression will be the primary outcome. Secondary outcomes will include emotion regulation, quality of life, and resilience. Treatment acceptance and usability will also be measured. Primary and secondary outcomes will be obtained at pre- and post-intervention measurements, and at the 3-month follow-up for all groups.DiscussionTo our knowledge, this is the first RCT that evaluates the efficacy of an APP-based EMI to improve emotion regulation skills in healthcare workers. This type of intervention might ultimately help disseminate treatments and reach a larger number of individuals than traditional face-to-face individual therapies.Trial registrationClinicalTrial.gov: NCT04958941 Registered 7 Jun 2021.Study statusParticipant recruitment has not started.

Suicide Prevention in Your Pocket: A Systematic Review of Ecological Momentary Interventions for the Management of Suicidal Thoughts and Behaviors.

This study reviews the evidence on ecological momentary interventions (EMIs) for managing and preventing suicidal thoughts and behaviors. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Its protocol was registered in the PROSPERO database. We conducted a systematic literature search of five databases: PubMed, EMBASE, Web of Science, PsycInfo, and Cochrane library. The most recent search date was 10 September 2021. After screening and full-text review, 27 studies were included, totaling 19 different interventions. Many of the available interventions have not yet been clinically tested. Those that have undergone effectiveness evaluation (10 interventions) showed good rates of effectiveness and feasibility, with some exceptions. The most widely used intervention model is the safety plan, which allows the user to implement coping and distracting strategies in case of suicidal ideation. Ecological momentary interventions provide certain advantages, such as their wide availability, versatility, and potential for customization. These interventions can be useful complements to traditional care, especially in situations in which face-to-face care is not possible. Evidence on the effectiveness of such interventions is still scarce. Furthermore, barriers limiting implementation in clinical practice remain. The constant advance of technology means that these interventions have great potential for improvement in the coming years.

Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study.

BackgroundMen who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes.ObjectiveThis study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs.MethodsBetween January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app.ResultsParticipants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions).ConclusionsMobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM.

A time-lagged study of predictors of paranoia and psychotic-like experiences in daily life across the schizotypy continuum.

Leading theoretical models of psychosis implicate a wide range of psychological factors in the development of positive symptoms. Ambulatory assessment allows us to repeatedly assess people's mental experiences within and across days to explore putative moment-to-moment prospective relationships that impact the onset and exacerbation of positive symptoms. This study used experience sampling methodology to examine the putative temporal associations of both risk and protective factors (negative emotional states, stress, self-esteem, and social appraisals) with the experience of paranoia and other positive psychotic-like experiences (PLE) in daily-life. A combined sample of 178 participants including 65 high-schizotypy, 74 at-risk mental states for psychosis, and 39 first-episode psychosis individuals was assessed repeatedly over seven consecutive days. Sadness, anxiety, stress, and negative social appraisals predicted higher levels of subsequent paranoia and PLE. In contrast, self-esteem and subjective appraisals of social support and social closeness predicted lower levels of paranoia and PLE. Most findings did not vary across subclinical, at-risk, and clinical levels of psychosis expression. Results support psychological models of psychosis and provide new evidence to disentangle psychological factors involved in the mechanistic pathways to positive symptoms. The findings can help the design of ecological momentary interventions delivered in real-time aimed at buffering psychological mechanisms that promote psychotic symptoms and strengthening causal mechanisms that protect from the development of positive symptoms. Finally, findings suggest that highly similar psychological mechanisms are implicated in the development of psychotic experiences across nonclinical, subclinical, and clinical expressions of schizotypy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluation of an Ecological Momentary Intervention for Depression in Older Adults Living Alone

Depression is a common but treatable mental health problem among older adults. Daily management and monitoring is very important; thus, diverse approaches have been developed. The objective of this research was to develop and pilot-test a counseling-plus-mobile health (mHealth) intervention using ecological momentary intervention (EMI) to reduce daily depressive mood for older adults living alone. Of 64 older adults living alone in community settings, 44 completed mHealth training and EMI for 7 weeks between October 2018 and October 2019. Study participants were randomized into experimental and control groups. The intervention was based on the protocol developed for an mHealth program for older Korean adults. Participants wore an actiwatch that measured their depressed moods four times a day for 2 weeks. Depressive symptoms were measured using the Hamilton Depression Rating Scale (K-HDRS) and the Korean version of the Short Geriatric Depression Scale (SGDS-K). Sleep quality was assessed using the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K). The mean age of the study sample was 76.05±5.66 years, and the majority of the participants were female (61.0%, 36/59). There were no demographic characteristic differences between intervention and control groups. Based on multi-level modeling, EMI was not associated with significant improvements in depressive symptoms. However, depressive symptoms showed an initial decreasing trend, leveling off toward the end of the intervention period. This study finding could function as preliminary data to develop mHealth-based EMIs for older users in a larger, long-term study.

Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial.

BackgroundMost mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care.ObjectiveThis study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth—EMIcompass.MethodsIn an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up.ResultsThe first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021.ConclusionsThis study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision.Trial RegistrationGerman Clinical Trials Register DRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265International Registered Report Identifier (IRRID)DERR1-10.2196/27462

Long-Term and Transfer Effects of an Action Control Intervention in Overweight Couples: A Randomized Controlled Trial Using Text Messages.

Keeping a physically active lifestyle requires consistent self-regulatory effort such as action control (e.g., continuously monitoring and evaluating a behavior in terms of one’s goals). Involving the romantic partner in interventions might be particularly effective in the long run. The present study examined the long-term and transfer effects of an action control intervention in couples using text messaging for promoting target persons’ and partners’ physical activity, anthropometric measures and physical fitness 6 months post baseline. A total of 121 overweight and obese romantic couples, randomly allocated to an intervention (n = 60; information + action control text messages) or a control group (n = 61; information only) and to participating as target person or partner, completed baseline assessments (T1). 100 couples (82.6%) completed the 6-month follow-up (T3) assessment. Primary outcomes included self-reported moderate-to-vigorous physical activity (MVPA) and objective MVPA and MVPA adherence using triaxial accelerometers across a diary period of 14 days after T3. Secondary outcomes included BMI, waist-to-hip circumference and physical fitness (target persons only) using a submaximal aerobic cycle test. At T3, there were no significant between-group differences between target persons and partners with regard to their objective MVPA, self-reported MVPA, BMI, waist-hip ratio or physical fitness. No significant changes in outcomes were observed from T1 to T3; however, changes in BMI from T1 to T3 between target persons and partners in the intervention group were associated. Overall, the brief 14-days action control intervention was not effective in improving target person’s physical activity, body measures and physical fitness in the long-term. Moreover, no long-term benefits for partners emerged. While brief ecological momentary interventions might be a promising tool for short-term effects, future studies are needed to test features enhancing long-term effectiveness. Associations in romantic partners’ changes suggest that dyadic interventions can be a promising approach, as changes induced in one partner may then transfer over to the other (controlled-trials.com ISRCTN15705531).

Smartphone-Delivered Ecological Momentary Interventions Based on Ecological Momentary Assessments to Promote Health Behaviors: Systematic Review and Adapted Checklist for Reporting Ecological Momentary Assessment and Intervention Studies.

BackgroundHealthy behaviors are crucial for maintaining a person’s health and well-being. The effects of health behavior interventions are mediated by individual and contextual factors that vary over time. Recently emerging smartphone-based ecological momentary interventions (EMIs) can use real-time user reports (ecological momentary assessments [EMAs]) to trigger appropriate support when needed in daily life.ObjectiveThis systematic review aims to assess the characteristics of smartphone-delivered EMIs using self-reported EMAs in relation to their effects on health behaviors, user engagement, and user perspectives.MethodsWe searched MEDLINE, Embase, PsycINFO, and CINAHL in June 2019 and updated the search in March 2020. We included experimental studies that incorporated EMIs based on EMAs delivered through smartphone apps to promote health behaviors in any health domain. Studies were independently screened. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. We performed a narrative synthesis of intervention effects, user perspectives and engagement, and intervention design and characteristics. Quality appraisal was conducted for all included studies.ResultsWe included 19 papers describing 17 unique studies and comprising 652 participants. Most studies were quasi-experimental (13/17, 76%), had small sample sizes, and great heterogeneity in intervention designs and measurements. EMIs were most popular in the mental health domain (8/17, 47%), followed by substance abuse (3/17, 18%), diet, weight loss, physical activity (4/17, 24%), and smoking (2/17, 12%). Of the 17 studies, the 4 (24%) included randomized controlled trials reported nonstatistically significant effects on health behaviors, and 4 (24%) quasi-experimental studies reported statistically significant pre-post improvements in self-reported primary outcomes, namely depressive (P<.001) and psychotic symptoms (P=.03), drinking frequency (P<.001), and eating patterns (P=.01). EMA was commonly used to capture subjective experiences as well as behaviors, whereas sensors were rarely used. Generally, users perceived EMIs to be helpful. Common suggestions for improvement included enhancing personalization, multimedia and interactive capabilities (eg, voice recording), and lowering the EMA reporting burden. EMI and EMA components were rarely reported and were not described in a standardized manner across studies, hampering progress in this field. A reporting checklist was developed to facilitate the interpretation and comparison of findings and enhance the transparency and replicability of future studies using EMAs and EMIs.ConclusionsThe use of smartphone-delivered EMIs using self-reported EMAs to promote behavior change is an emerging area of research, with few studies evaluating efficacy. Such interventions could present an opportunity to enhance health but need further assessment in larger participant cohorts and well-designed evaluations following reporting checklists. Future research should explore combining self-reported EMAs of subjective experiences with objective data passively collected via sensors to promote personalization while minimizing user burden, as well as explore different EMA data collection methods (eg, chatbots).Trial RegistrationPROSPERO CRD42019138739; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=138739

Across the continuum: Associations between (fluctuations in) momentary self-esteem and psychotic experiences

ObjectiveLow self-esteem has been suggested as a putative mechanism in the development and maintenance of psychosis. Uncertainty still exists about how unstable self-esteem relates to psychotic experiences. The present study examines the potential (temporal) associations between momentary self-esteem, fluctuations in self-esteem, and psychotic experiences in daily life. MethodsExperience sampling data were collected from 46 individuals presenting with an at-risk mental state (ARMS), 51 individuals with first-episode psychosis (FEP), and 53 controls, to investigate associations between (fluctuations in) self-esteem and psychotic experiences within and across FEP, ARMS, and controls, using linear mixed models. ResultsIn all three groups we found that lower momentary self-esteem was associated with a greater intensity of psychotic experiences (adj. βFEP = −0.15, 95% CI -0.20 to −0.10, p = 0.000; adj. βARMS = −0.20, 95% CI -0.26 to −0.15, p = 0.000; adj. βcontrols = −0.12, 95% CI -0.17 to −0.07, p = 0.000). Variability in momentary self-esteem was associated with a greater intensity of psychotic experiences only in ARMS (adj. βARMS = 0.08, 95% CI 0.04 to 0.11, p = 0.000) and controls (adj. βcontrols = 0.04, 95% CI 0.01 to 0.08, p = 0.023). For instability this association held only in controls (adj. βcontrols = 0.03, 95% CI 0.00 to 0.05, p = 0.020). Furthermore, findings may suggest a reciprocal temporal association between self-esteem and psychotic experiences. ConclusionsOur findings suggest that self-esteem may be an important mechanism targetable by ecological momentary interventions to reduce the intensity of psychotic experiences and potentially prevent illness progression at an early stage.

In Search of Digital Dopamine: How Apps Can Motivate Depressed Patients, a Review and Conceptual Analysis.

Introduction: Depression is highly prevalent and causes considerable suffering and disease burden despite the existence of wide-ranging treatment options. Momentary assessment is a promising tool in the management of psychiatric disorders, and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. Treating the motivational and hedonic aspects of depression is a key target reported in the literature, but it is time-consuming in terms of human resources. Digital Applications offer a major opportunity to indirectly regulate impaired motivational circuits through dopaminergic pathways. Objective: The main objective of this review was twofold: (1) propose a conceptual and critical review of the literature regarding the theoretical and technical principles of digital applications focused on motivation in depression, activating dopamine, and (2) suggest recommendations on the relevance of using these tools and their potential place in the treatment of depression. Material and Methods: A search for words related to “dopamine”, “depression”, “smartphone apps”, “digital phenotype” has been conducted on PubMed. Results: Ecological momentary interventions (EMIs) differ from traditional treatments by providing relevant, useful intervention strategies in the context of people’s daily lives. EMIs triggered by ecological momentary assessment (EMA) are called “Smart-EMI”. Smart-EMIs can mimic the “dopamine reward system” if the intervention is tailored for motivation or hedonic enhancement, and it has been shown that a simple reward (such as a digital badge) can increase motivation. Discussion: The various studies presented support the potential interest of digital health in effectively motivating depressed patients to adopt therapeutic activation behaviors. Finding effective ways to integrate EMIs with human-provided therapeutic support may ultimately yield the most efficient and effective intervention method. This approach could be a helpful tool to increase adherence and motivation. Conclusion: Smartphone apps can motivate depressed patients by enhancing dopamine, offering the opportunity to enhance motivation and behavioral changes, although longer term studies are still needed.

10.G. Workshop: Digital interventions for improving public mental health

Abstract While current routine mental health services provide a range of treatment options for individuals with mental health conditions, specialized support remains difficult to access and tailoring interventions to service users' needs remains challenging. Similarly, the use of, and access to, measures for prevention and mental health promotion continues to be limited, as these are often not tailored to individual needs, preferences, and real-world settings. There is increasing interest in utilizing digital health technologies for improving public mental health provision (i.e., mental health promotion, prevention and treatment of mental disorders) as they allow for adaptive, scalable, real-time, and real-world delivery of intervention components in individuals' daily life. This has driven the development of novel internet-based (eHealth) and app-based mobile health (mHealth) interventions for various mental health outcomes of which ecological momentary interventions (EMIs) represent a powerful approach. To accomplish this, novel research concepts (e.g., living labs) are increasingly being used to develop, optimize, evaluate, and implement digital interventions in routine public mental health provision through a transdisciplinary approach that involves users from the target population and relevant stakeholders throughout the research process to facilitate co-production and lowering barriers of implementation. The workshop's objective is to exemplify the multifaceted use of digital intervention in areas of public mental health and diverse communities and settings. This will include a) novel approaches to modifying continuum beliefs about mental health and an online anti-stigma intervention, b) an EMI to reduce suicide risk among adolescents (EMIRA), c) a self-Help app for Syrian refugees with posttraumatic stress (Sanadak), d) a location-based game to promote (mental) health literacy of adolescents (Nebolus), and e) an artificial intelligence-informed mHealth training for mental health promotion and prevention in adolescents and young adults (AI4U). The discussion will be led by Prof. Steffi Riedel-Heller, MD, MPH, and will focus on the benefits and opportunities afforded by digital technologies in public mental health provision. Key messages Digital interventions signal great promise for improving public mental health. There is a need to carefully evaluate digital interventions before implementation or making them publicly available.

Ecological momentary intervention to reduce suicide risk among adolescents (EMIRA)

Abstract Suicide is among the leading causes of death among adolescents and suicide risk is particularly high after discharge from psychiatric inpatient care. Therefore, interventions to reduce suicidal thoughts and behaviours (STBs) among adolescents discharged from psychiatric inpatient care are integral for successful suicide prevention among this group. However, such interventions are scarce. EMIRA aims to close this important gap in mental health services by developing an ecological momentary intervention (i.e., intervention delivered in real-time and within one's natural setting) consisting of a personalized, automatically triggered crisis support smartphone app to reduce STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. First, we will conduct qualitative interviews with adolescents aged 14-21 years who previously experienced STBs, their parents and health care providers to identify their intervention needs and safety concerns regarding ecological momentary assessment (EMA). Next, we will investigate the short-term variability of STBs and their cognitive and physiological risk factors among adolescents aged 14-21 years using EMA (app-based self-report + wrist worn device). Based on our results and past research we will develop a personalized crisis support smartphone app (mobile safety planning) that is not only self-accessible but starts automatically based on the presence of pre-identified STB risk factors. Finally, we will conduct two consecutive studies to test the feasibility, efficacy and cost-effectiveness of the developed ecological momentary intervention in reducing STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. EMIRA has great potential to close a crucial gap in adolescent mental health services and significantly improve suicide prevention among this group.

Living lab AI4U - artificial intelligence for personalized digital mental health promotion and prevention in youth

Abstract Background Youth are particularly affected by mental health problems, but their use of preventive interventions remains limited. The advances in Artificial Intelligence (AI) enable the development of digital interventions for mental health promotion and prevention. This applies to ecological momentary interventions (EMI), which offer adaptive training components in daily life. Methods In a preparatory phase, focus groups (N = 2, aged: 15-21 years) and a representative survey (N = 666, aged: 16-24) with young individuals as well as qualitative interviews with stakeholders in routine public mental health provision were conducted. Results None of the stakeholders used digital interventions in their everyday work but were interested in their use. The importance of data protection and security, usability, and participation of the target population in all stages of the research process was emphasized. The risk of a digital divide, acceptance of used terminology, and difficulties of structural embedding were mentioned as important barriers for successful implementation. Young individuals had a positive attitude toward digitization and AI and their use in mental health promotion and prevention and underlined the importance of practical benefits for users. They had a pragmatic attitude toward data use policies. Around 70% of young individuals were already using mHealth apps. Psychological distress was associated with the use of, and positive attitude towards, mHealth apps. Discussion Findings have contributed to the ongoing main phase. The living lab AI4U will be carried out in transdisciplinary projects involving direct participation of relevant stakeholders, users from the target population and an interdisciplinary research group. Each of these projects includes one or more real-world experiments. These will be embedded in a transdisciplinary infrastructure, which will ensure ongoing quality assurance, sustainability assessment, public relations and networking.

Digital life in a networked world: opportunities and risks for psychiatry

In dieser Übersicht werden Chancen und Risiken der digitalen Transformation in ihrer Bedeutung für die Diagnostik und Therapie psychischer Erkrankungen unter dem Aspekt der Konvergenz neuer digitaler Technologien thematisiert. Die Möglichkeiten Smartphone-basierter Technologien für die Erfassung des lebensweltlichen Kontextes werden erläutert und anhand zweier aktueller Forschungsergebnisse die Anwendung dieses Ansatzes auf die Untersuchung von Resilienzmechanismen zur Verbesserung der psychischen Befindlichkeit dargestellt. Im Anschluss wird die zunehmende Vernetzung des Umweltkontextes selber vor dem Hintergrund des sog. „internet of things“ (IoT) in den Blick genommen. Diese konvergierenden Technologien ermöglichen in Kombination mit neuen Entwicklungen in der künstlichen Intelligenz eine neue Generation von Interventionen in der Lebenswelt („ecological momentary interventions“, EMI), die sich auf innovative Sensoren, lokale Berechnungen des lebensweltlichen Kontextes und deren Bewertung mithilfe der künstlichen Intelligenz stützen.

Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial

Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemination of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. Individuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant's responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to-treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help. Trial registrationClinicaltrials.gov as NCT04074681. Registered 22 July 2019.

Project CHOICE: Choosing healthy options in coping with emotions, an EMA/EMI plus in-person intervention for alcohol use

Background: Emerging adulthood (18–25 years) represents a risky time for mental health and substance use. Emerging adults are particularly susceptible to problematic patterns of substance use, especially if they experience anxiety and/or depression and use substances as a way to cope with such issues. However, many mental health treatments do not address substance use. We developed an ecological momentary assessment and intervention (EMA/EMI) to specifically target the motive of drinking to cope with anxiety/depression. Methods: Project CHOICE was a 6-week intervention that paired in-person normative feedback with daily EMA and, if an individual reported negative affect and intent to drink, an EMI was immediately sent to their phone (a personally-chosen coping skill). We recruited n = 20 (55% female, mean age 21.74, 85% Caucasian and 75% non-Hispanic/Latino) individuals from a psychiatric partial hospitalization program for a 6-week open trial of the CHOICE intervention and re-assessed at the 6-week follow-up point. Results: Results indicated that drinking variables and coping motives were highly correlated at baseline. Days of drinking, alcohol-related problems, and coping motives significantly decreased over time following the intervention. Results indicated high levels of feasibility and acceptability. Conclusions: This open pilot represents a feasible, acceptable, and promising direction in delivering interventions in the moment when risk is highest, utilizing smartphone capabilities.

A Group Intervention for Motivational Deficits: Preliminary Investigation of a Blended Care Approach Using Ambulatory Assessment.

Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of "Switch," an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants' smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants' activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.

An Ecological Momentary Intervention Study of Emotional Responses to Smartphone-Prompted CBT Skills Practice and the Relationship to Clinical Outcomes

The practice of therapeutic skills outside of sessions in which they are learned is one presumed key component of cognitive behavioral therapy (CBT). Yet, our understanding of how skills practice relates to clinical outcomes remains limited. Here, we explored patients’ emotional responses to CBT skills practice in a pilot study pairing smartphone-app-delivered skills reminders and guided practice (ecological momentary intervention [EMI]) using ecological momentary assessment (EMA). Participants (n = 25) were adults recently hospitalized for a suicide attempt or severe suicidal thinking. They received brief inpatient CBT (1 to 3 sessions covering core CBT skills from the Unified Protocol), followed by 1 month of EMI and EMA after discharge. On average, participants reported modest reductions in negative affect after skills use (i.e., immediate responses; median time elapsed = 4.30 minutes). Additionally, participants tended to report less negative affect when the timepoint preceding the current assessment included EMI skills practice, rather than EMA alone (i.e., delayed responses; median time elapsed between prompts = 2.17 hours). Immediate effects were unrelated to longer-term clinical outcomes, whereas greater delayed effects were associated with lower symptom severity at follow-up. Future studies should further examine how CBT skills use in daily life may alleviate symptoms.