Smartphone-based Ecological Momentary Assessment Research Articles

Using ecological momentary assessments of negative affect and craving during residential opioid use disorder treatment to predict patients' relapse to substance use

BackgroundNegative affect (NA) and craving are often independently examined as precipitators of relapse among individuals with substance use disorders, including opioid use disorder (OUD). Recent ecological momentary assessment (EMA) research has revealed that NA and craving frequently co-occur within individuals. Yet we know little about the general patterns of, and variability in, within-person associations between NA and craving, as well as whether the nature and degree of within-person NA-craving coupling predicts post-treatment time-to-relapse. MethodsSeventy-three patients (77 % male, Mage = 30.10, Range = 19–61) in residential treatment for OUD took part in a 12-day, 4× daily smartphone-based EMA study. Linear mixed-effects models tested within-person, day-level associations between self-reported NA and craving during treatment. The study used Person-specific slopes (i.e., average within-person NA-craving coupling for each participant) estimated from the mixed-effects model in survival analyses with Cox proportional hazards regression models to determine if between-person differences in the within-person coupling predicted post-treatment time-to-relapse (operationalized as the return to problematic use of any substance except tobacco), and whether this prediction was similar across patients' average levels of NA and craving intensity. The study monitored relapse through a combination of hair samples and reports from patients or alternative contacts via a voice response system twice a month for up to 120 days or more following discharge. ResultsAmong the 61 participants with time-to-relapse data, those with stronger positive within-person NA-craving coupling on average during residential OUD treatment had a lower hazard of relapsing (slower time to relapse) post-treatment than participants with weaker NA-craving slopes. The significant association held after controlling for interindividual differences in age, sex, and average levels of NA and craving intensity. Average NA and craving intensity did not moderate the association between NA-craving coupling and time-to-relapse. ConclusionsInterindividual differences in average within-person, day-level NA-craving coupling during residential treatment predict OUD patients' post-treatment time-to-relapse.

UNDERSTANDING MOBILITY, HEALTH, AND WELL-BEING OF OLDER ADULTS USING SENSING TECHNOLOGIES

Abstract Mobility has been identified as one important ingredient to older adults’ health and well-being and is considered a high priority in the global agenda of healthy and active aging. However, mobility is still a relatively understudied concept in aging research. This symposium, including three empirical studies and one concept paper, presents how different sensing technologies can be utilized to examine mobility, health and well-being in older adults. Using infrared motion sensors and contact sensors, Wu and colleagues examine indoor mobility and show its associations with physical, cognitive, and mental health in community-dwelling older adults living alone. Luo and colleagues use a custom-built mobile GPS sensor and a smartphone-based ambulatory assessment to examine daily mobility and well-being in community-dwelling older adults. They find that a day with larger life space area, more time spent in passive transport modes, and higher number of different locations is associated with higher daily life satisfaction. Similarly, using a GPS sensor combined with a smartphone-based ecological momentary assessment, Kamalyan and colleagues examine life-space mobility, social interactions, and well-being in older adults with and without HIV. They show that prior day’s at-home time is negatively associated with current day’s happiness and that prior day’s social interactions diminishes this association. Jansen presents a project combining sensor-based movement data, GPS-based geolocation data, and experience sampling to investigate relations between life-space mobility and social participation and the role of cultural and climatic differences across several European countries. Hans-Werner Wahl will discuss all papers from an ecological and contextualized aging perspective.

SOCIAL INTERACTIONS REDUCE ASSOCIATION BETWEEN LIFE-SPACE AND DAILY HAPPINESS IN OLDER ADULTS WITH AND WITHOUT HIV

Abstract Objective We used global positioning system (GPS) derived indicators and ecological momentary assessment (EMA) to assess real-time relationships between life-space, mood, and social interactions among older adults with and without HIV. Methods Participants (People with HIV [PWH] n=54, HIV- n=34) completed smartphone-based EMA surveys assessing mood and social interactions four times/day for 14-days. Participants’ smartphones were GPS enabled. Mixed-effects models analyzed concurrent and lagged associations among life-space and mood. Results PWH spent more time at home (79% vs 70%, z=-2.08; p=.04) and reported lower mean happiness (3.2 vs 3.7; z=2.63; p=.007). More daily social interactions were associated with higher ratings of real-time happiness (b=0.12; t=5.61; p< 0.001). Prior day social interactions (b=0.15; t=7.3; p<.0001) and HIV status (b=-0.48; t=-2.56; df= 1026.8; p=0.01) diminished the effect of prior day time spent at home on happiness. Conclusions Interventions targeting social interaction may help increase positive mood in isolated older adults.

Six-Month Clinical and Ecological Momentary Assessment Follow-Up of Patients at High Risk of Suicide

Objective: In this study, we combined ecological momentary assessment (EMA) with traditional clinical follow-up to explore correlates of suicidal relapse in patients with a history of suicidal behavior. Methods: Over 6 months, we followed up with 393 patients who completed baseline and follow-up interviews and were monitored through smartphone-based EMA via the MEmind app. Recruitment was conducted between February 2018 and March 2020. We recorded the occurrence of clinical suicidal events and EMA suicidal events, the latter defined as extreme scores on questions on passive suicide ideation. Results: Fifteen percent of participants had a new clinical suicidal event during follow-up (9.2% suicide attempt ; 5.9% emergency referral for suicidal ideation ). Of the 319 participants who installed the MEmind app, 20.7% presented with EMA suicidal events. EMA suicidal events were statistically significantly associated with clinical suicidal events at 2-month follow-up but not at 6-month follow-up. In the Cox multivariate regression model, 5 factors were independently associated with clinical suicidal events: number of previous SAs, SA in the past year, SA in the past month (risk factors), female gender, and age (protective factors). Conclusions: Our study confirms some of the risk factors classically associated with risk of suicide reattempt, such as history of suicidal behavior, while questioning others, such as female gender. Risk factors associated with EMA events differed from risk factors associated with traditional clinical suicide events, supporting the existence of distinct suicidal phenotypes.

Real-time Associations between Functional Behaviors and Depressed Mood in Post-stroke Individuals: Smartphone-based Ecological Momentary Assessment

<h3>Research Objectives</h3> To assess real-time associations between daily functional behaviors and depressed mood (DM) in indivdiuals after stroke using smartphone-based ecological momentary assessment (EMA). <h3>Design</h3> EMA involved repeated sampling of real-time daily functional activities and DM in stroke survivors' natural environments. We used multilevel models to examine concurrent and time-lagged associations between daily functional behaviors and DM. <h3>Setting</h3> Home and community. <h3>Participants</h3> Two hundred and two participants with mild-to-moderate chronic stroke participants (90% ischemic stroke; 45% female; 44% black). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Participants completed EMA five times per day for two weeks by reporting their daily functional behaviors regarding where, with whom, and what activity was spent and their DM level. <h3>Results</h3> Participants spent 28% of the wake-up time in passive leisure activities but spent less time in physical and vocational activities (4% and 9%, respectively). Lower DM was concurrently associated with time spent in social activities (β=-0.023 ± 0.011) and instrumental activities of daily living (β=-0.061 ± 0.013); spending time with family members (β=-0.061 ± 0.014), spouses (β=-0.043, ± 0.016), friends (β=-0.094, ± 0.021), and coworkers (β=-0.050 ± 0.021); locating in restaurants (β=-0.068 ± 0.029), and homes of family members (β=-0.039 ± 0.020) or friends (β=-0.069 ± 0.031). DM was reported higher when patients rated lower in perceived satisfaction, performance, and engagement of activities in concurrent (βs=-0.036 ± 0.003, -0.053 ± 0.003, -0.044 ± 0.003) and time-lagged models (βs=-0.011 ± 0.004, -0.012 ± 0.004, -0.013 ± 0.004). <h3>Conclusions</h3> EMA can delineate real-time associations between post-stroke functional behaviors and DM. Findings suggest promoting participation in social activities and instrumental activities of daily living as important intervention targets to reduce DM in stroke survivors. <h3>Author(s) Disclosures</h3> None disclosed.

Examining whether affectively-charged motivations predict subsequent affective response during physical activity: An ecological momentary assessment study.

Evidence suggests positive affective response during physical activity increases the likelihood of engaging in and maintaining regular activity exercise in the future. Elucidating antecedents for a positive affective response may help identify intervention strategies to increase activity. Affectively-charged motivations (e.g., desires, urges, dreading) have been posited as proximal antecedents to physical activity but have yet to be examined in terms of their influence on affective response in real-world settings. The current study used ecological momentary assessment (EMA) to examine within-subject effects of pre-physical activity affectively-charged motivation on subsequent affective response during physical activity. Participants included 56 adults (M = 39.18 years, SD = 11.98; 67.86% female) who completed a 14-day smartphone-based EMA study. Prior to starting physical activity (time t), participants self-initiated an event-contingent EMA survey that assessed affectively-charged motivation for physical activity (i.e., rating scale from "dreading it" to "excited to do it"). EMA surveys prompted during subsequent physical activity (time t + 15 min) assessed affective response (i.e., feeling good-bad, energized-exhausted, thrilled-miserable, interested-bored, and relaxed-nervous). Multi-level linear regression models examined within-subject effects of pre- physical activity affectively-charged motivations on subsequent affective response during physical activity controlling for between-subjects effects of affectively-charged motivation, age, biological sex, time of day, and day of the week. Overall, there were N = 304 physical activity occasions in the analysis (M = 5.43, SD = 3.97). When individuals reported more positive affectively-charged motivation for physical activity than usual before physical activity occasions, they reported feeling more energized (Estimate = 0.22, p < 0.001), good (Estimate = 0.25, p < 0.001), thrilled (Estimate = 0.12, p = 0.02), and interested (Estimate = 0.24, p < 0.001) during subsequent physical activity. Affectively-charged motivation was not associated with feeling more relaxed (Estimate = 0.11, p = 0.13) during subsequent physical activity. Momentary affectively-charged motivations predicted more positive affective response during subsequent physical activity among active adults. Future research can explore potential sources of intraindividual differences in affectively-charged motivations and further examine these associations with future physical activity behavior. To improve positive affective responses, interventions may boost affectively-charged motivations through real-time mobile prompting in naturalistic settings.

Smartphone-based ecological momentary assessment reveals mental health benefits of birdlife

The mental health benefits of everyday encounters with birdlife for mental health are poorly understood. Previous studies have typically relied on retrospective questionnaires or artificial set-ups with little ecological validity. In the present study, we used the Urban Mind smartphone application to examine the impact of seeing or hearing birds on self-reported mental wellbeing in real-life contexts. A sample of 1292 participants completed a total of 26,856 ecological momentary assessments between April 2018 and October 2021. Everyday encounters with birdlife were associated with time-lasting improvements in mental wellbeing. These improvements were evident not only in healthy people but also in those with a diagnosis of depression, the most common mental illness across the world. These findings have potential implications for both environmental and wildlife protection and mental healthcare policies. Specific measures, aimed at preserving and increasing everyday encounters with birdlife in urban areas, should be implemented.

Daily and Momentary Variability in Sleep, Stress, and Well-being Data in Two Samples of Health Care Workers

Ecological momentary assessment (EMA) can capture how sleep, stress, and well-being are related within individuals. However, the use of EMA involves participant burden, which may be a major barrier when studying at-risk populations like frontline workers. To guide future research interested in using EMA, this study examined variance components in sleep, stress, and well-being variables collected from health care workers. Two samples of hospital nurses (60 inpatient, 84 outpatient) responded to 2-week smartphone-based EMA. Adherence to the EMA protocol was good in both samples. Results from intraclass correlations showed more momentary variability in stressors and uplifts, more daily variability in sleep, fatigue, and physical symptoms, and more between-person variability in affect, rumination, and work quality. Across the variables, however, there was substantial within-person variability. Variance components were relatively consistent between workdays and non-workdays and between week 1 and week 2. Some nuanced between-sample differences were noted.

Smartphone-assisted guided self-help cognitive behavioral therapy for young people with distressing voices (SmartVoices): study protocol for a randomized controlled trial

BackgroundThe long-standing view that auditory verbal hallucinations (AVH) or hearing voices is a sign of schizophrenia has been challenged by research demonstrating that they lie on a continuum ranging from normal to pathological experience related to distress and need for care. Hearing voices is more prevalent in adolescence than in later life, and hearing voices during adolescence indicates a risk for severe psychopathology, functional impairments, and suicide later in life. While there is increasing evidence for the efficacy of cognitive behavioral therapy for voices (CBTv) in adults with schizophrenia, research on psychological treatments for youth with distressing voices has been scarce. The aim of the current study is to examine the efficacy of CBTv, delivered using smartphone-based Ecological Momentary Assessment Intervention (EMI) in a transdiagnostic sample of youth.MethodsThis is a superiority randomized controlled trial comparing 8 weeks of CBTv-based EMI in addition to treatment as usual (TAU) versus TAU only. TAU covers both no treatment and any form of psychiatric/psychological treatment. In the EMI condition, participants will be prompted twice a day to complete an EMA survey, and receive one intervention proposal per assessment. One-hundred fifty-four youth aged 14–25 years with distressing voices will be recruited from psychiatric clinics, local private practices, internet forums, and advertisements in print and social media. Before and after the intervention phase, participants will undergo a 9-day EMA. Single-blinded assessments will be conducted at baseline (T0) and at 3-month (T1) and 6-month (T2) follow-up. The primary outcome is the distress dimension of the Auditory Hallucinations subscale of the Psychotic Symptom Rating Scales at T1. Secondary outcomes include perceived hostile intention, power, and dominance of voices, passive, aggressive, and assertive relating to voices, and negative core beliefs about the self.DiscussionAdolescence provides a crucial window of opportunity for early intervention for hearing voices. However, youth are notoriously reluctant help-seekers. This study offers a low-intensity psychological intervention for youth with distressing voices beyond diagnostic boundaries that, using a mobile technology approach, may match the treatment preferences of the generation of “digital natives.”Trial registrationGerman Clinical Trials Register DRKS00026243. Registered on 2 September 2021

Data visualization as an intervention for pediatric chronic pain: a pilot feasibility study protocol for a randomized controlled crossover trial

BackgroundChronic pain is a common and costly condition in youth, associated with negative implications that reach far beyond the pain experience itself (e.g., interference with recreational, social, and academic activities, mental health sequelae). As a self-appraised condition, pain experience is influenced by patient’s biases and meaning-making in relation to their symptoms and triggers. We propose that interacting with self-reported data will impact the experience of pain by altering understanding and expectations of symptom experience and how pain interacts with other factors (e.g., sleep, emotions, social interactions). In this study, we aim to establish the feasibility and acceptability of using a data visualization platform to track and monitor symptoms and their relationship with other factors, versus simply daily reporting of symptoms using a smartphone-based Ecological Momentary Assessment (EMA).MethodsThis protocol is for a randomized, single-center, open-label crossover trial. We aim to recruit 50 typically developing youth aged 12–18 years with chronic pain to take part in two phases of data collection. The trial will utilize an A-B counterbalanced design in which participants will be randomly assigned to receive either Part A (EMA alone for 7 days) or Part B (EMA plus visualization platform for 7 days) first and then receive the opposite phase after a 7-day break (washout period). Key outcomes will be participant reports of acceptability and feasibility, EMA completion rates, barriers, and perceptions of the benefits or risks of participation. Secondary exploratory analyses will examine the relationship between EMA-reported symptoms over time and in relation to baseline measures, as well as pilot data on any improvements in symptoms related to engaging with the data visualization platform.DiscussionThis protocol describes the feasibility and pilot testing of a novel approach to promoting self-management and facilitating symptom appraisal using visualized data. We aim to determine whether there is a sufficient rationale, both from the perspective of feasibility and patient satisfaction/acceptability, to conduct a larger randomized controlled trial of this intervention. This intervention has the potential to support clinical care for youth with chronic pain and other conditions where self-appraisal and understanding of symptom patterns are a critical component of functional recovery.Trial registrationOpen Science Framework doi: https://doi.org/10.17605/OSF.IO/HQX7C. Registered on October 25, 2021, osf.io/hqx7c

Smartphone-Based Ecological Momentary Assessment for Collecting Pain and Function Data for Those with Low Back Pain.

Smartphone-based ecological momentary assessment (EMA) methods are widely used for data collection and monitoring in healthcare but their uptake clinically has been limited. Low back pain, a condition with limited effective treatments, has the potential to benefit from EMA. This study aimed to (i) determine the feasibility of collecting pain and function data using smartphone-based EMA, (ii) examine pain data collected using EMA compared to traditional methods, (iii) characterize individuals’ progress in relation to pain and function, and (iv) investigate the appropriation of the method. Our results showed that an individual’s ‘pain intensity index’ provided a measure of the burden of their low back pain, which differed from but complemented traditional ‘change in pain intensity’ measures. We found significant variations in the pain and function over the course of an individual’s back pain that was not captured by the cohort’s mean scores, the approach currently used as the gold standard in clinical trials. The EMA method was highly acceptable to the participants, and the Model of Technology Appropriation provided information on technology adoption. This study highlights the potential of the smartphone-based EMA method for enhancing the collection of outcome data and providing a personalized approach to the management of low back pain.

Daily association of stressors with perceived cognitive performance: Moderating role of age.

Stress can elicit both positive and negative impacts on cognition. Less is known about whether and how daily stressors are associated with perceived cognitive performance in healthcare workers. We examined daily associations between stressors and perceived cognitive performance in nurses and whether these associations differed by age or nursing tenure. Using 14-day smartphone-based ecological momentary assessment, 60 inpatient nurses at a U.S. cancer hospital reported the frequency and severity of daily stressors (e.g., arguments, accidents). Each day, participants subjectively evaluated their mental focus, memory, and processing speed. Multilevel modelling examined the within- and between-person associations of daily stressors with cognitive performance. More stressors were associated with poorer perceived cognitive performance at both within- and between-person levels for both daily stressor frequency and severity. For moderation by age, the within-person stressor severity-cognitive performance relationship was only significant for nurses who were younger, but not for those who were older. Similarly, the within-person associations of daily stressor frequency and severity with cognitive performance were only significant for nurses with a shorter tenure. Findings suggest daily stressors may degrade perceived cognitive performance in nurses and the impact may be stronger for those who are younger or with less experience on the job.

Daily Physical Activity-related Fluctuations In Body-awareness: An Ecological Momentary Assessment Study

The positive influence of physical activity on body-awareness is well documented, however little is known about acute within-person relationships in daily life. Identifying differences resulting from varying characteristics of physical activity could reveal important mechanistic information for interventions. PURPOSE: To assess daily physical activity-related fluctuations in body-awareness. METHODS: A seven-day smartphone-based ecological momentary assessment was completed by 32 students (Mage = 22.35 ± 2.20, 54% F, MBMI = 23.21 ± 2.65). Interoceptive accuracy, the accurate detection and tracking of internal bodily signals, was measured at baseline, whilst daily fluctuations in perceived body-awareness were measured using a validated questionnaire. Participants responded on physical activity-triggered smartphones, also reporting activity type across the last 15 minutes. RESULTS: Preliminary multi-level analyses revealed no association between accelerometer-assessed movement acceleration intensity and body-awareness (B = 0.00 p = .831). Considering physical activity type, however, we found significant increases following physical activity performed in a sport setting (B = 3.81, p = <0.001), yet no effect for daily physical activity e.g., walking upstairs (B = 0.09, p = .803). Furthermore, whilst interoceptive accuracy was associated with higher perceived body-awareness (B = 5.92, p = .041), no interaction with physical activity indicates that a better objective sense of the body did not moderate physical activity-related increases in perceived body-awareness. CONCLUSIONS: Characteristics e.g., context appear to moderate daily physical activity-related fluctuations in perceived body-awareness. More specifically, physical activity in a sport setting appeared to have distinct effects, whereas daily physical activity did not. This may be due to different motivational and attentional mechanisms between the two contexts, in line with previous research supporting the equal importance of cognitive (e.g., attention towards bodily signals) and physiological (e.g., salience of bodily signals) adaptations. These findings should inform future research investigating within-person determinants of body-awareness, taking characteristics of physical activity into consideration.

Using smartphone-based ecological momentary assessment and personalized feedback for patients with chronic cancer-related fatigue: A proof-of-concept study

IntroductionChronic cancer-related fatigue (CCRF) is a complex multidimensional problem warranting person-centered care. Providing patients and therapists personalized feedback based on network analysis applied to ecological momentary assessment (EMA) data could facilitate case conceptualization in psycho-oncological care. The aim was to explore patients' and therapists' experiences of using an EMA app and personalized feedback based on network theory to aid case conceptualization in psycho-oncological care. MethodsA n = 5 proof-of-concept study was implemented in routine psycho-oncological care. We purposively selected adult cancer patients suffering from severe CCRF who were on the waitlist for psycho-oncological care. During a 3-week period participants filled out the EMA app Energy InSight (fatigue, mood, activity, responding, and context) five times a day. Participants received a descriptive and network feedback report, which they reflected upon during the first therapy sessions. Thematic analysis was used to analyze user experiences. ResultsPatients experienced that filling out the Energy InSight app, as well as receiving descriptive and network-based personalized feedback provided them with insight into their CCRF. Although therapists experienced the discussion of network feedback as challenging, it facilitated the case conceptualization. DiscussionUsing EMA during waitlist for psychological care seemed feasible. Patients experienced beneficial effects from filling out the EMA app and talking over the personalized feedback reports, which in turn aided case conceptualization and personalized care. Based on this evaluation, an improved version of the Energy InSight app and a therapist training for providing network feedback is developed for implementation in psycho-oncological care.

The effects of momentary loneliness and COVID-19 stressors on hypothalamic–pituitary adrenal (HPA) axis functioning: A lockdown stage changes the association between loneliness and salivary cortisol

The COVID-19 pandemic can be characterized as a chronic stressor affecting the hypothalamic–pituitary–adrenal (HPA) axis, indexed by glucocorticoids (e.g., cortisol). We investigated whether salivary cortisol level is increased during a lockdown and whether a lockdown condition affects the association between loneliness, specific COVID-19 related stressors and salivary cortisol level. We conducted a smartphone-based ecological momentary assessment (EMA) study with 280 participants in Germany who experienced at least mild loneliness and distress amid COVID-19 from August 2020 to March 2021. We measured their momentary loneliness and COVID-related stressors including worries, information seeking behaviors and feelings of restriction during “no-lockdown” or “lockdown” stages amid COVID-19. Their salivary cortisol was measured 4 times on the last day of a 7-day EMA study. We found a significant increase in salivary cortisol levels during lockdown compared to no-lockdown. Lockdown stage was found to moderate the relationship between momentary loneliness and salivary cortisol level, i.e., loneliness was positively related to cortisol level specifically during lockdown. Mechanisms explaining the effect of forced social isolation on the association between loneliness and salivary cortisol need to be investigated in future studies.

The Association of Embracing with Daily Mood and General Life Satisfaction: An Ecological Momentary Assessment Study

Embracing has several positive health effects, such as lowering blood pressure and decreasing infection risk. However, its association with general life satisfaction and daily mood has not been researched in detail. Here, we used a smartphone-based ecological momentary assessment (EMA) approach to monitor the daily number of embraces and daily mood in a sample of 94 adults over the course of seven days. We found that embracing frequency differed slightly over the week, with embracing occurring more frequently on weekends than on weekdays. We also found that higher daily embracing frequencies were associated with better daily mood using multilevel modeling. Only singles benefitted from increases in average embracing regarding their life satisfaction, whereas individuals in a relationship were unaffected by their embracing tendencies. Although our results are strictly correlational and do not indicate any direction or causality, embraces may be important for daily mood and general life satisfaction, but their efficacy seems to depend on relationship status.

Smartphone-Based Ecological Momentary Assessment for the Measurement of the Performance Status and Health-Related Quality of Life in Cancer Patients Under Systemic Anticancer Therapies: Development and Acceptability of a Mobile App.

BackgroundWe have defined a project to develop a mobile app that continually records smartphone parameters which may help define the Eastern Cooperative Oncology Group performance status (ECOG-PS) and the health-related quality of life (HRQoL), without interaction with patients or professionals. This project is divided into 3 phases. Here we describe phase 1. The objective of this phase was to develop the app and assess its usability concerning patient characteristics, acceptability, and satisfaction.MethodsThe app eB2-ECOG was developed and installed in the smartphone of cancer patients who will be followed for six months. Criteria inclusion were: age over 18-year-old; diagnosed with unresectable or metastatic lung cancer, gastrointestinal stromal tumor, sarcoma, or head and neck cancer; under systemic anticancer therapies; and possession of a Smartphone. The app will collect passive and active data from the patients while healthcare professionals will evaluate the ECOG-PS and HRQoL through conventional tools. Acceptability was assessed during the follow-up. Patients answered a satisfaction survey in the app between 3-6 months from their inclusion.ResultsThe app developed provides a system for continuously collecting, merging, and processing data related to patient’s health and physical activity. It provides a transparent capture service based on all the available data of a patient. Currently, 106 patients have been recruited. A total of 36 patients were excluded, most of them (21/36) due to technological reasons. We assessed 69 patients (53 lung cancer, 8 gastrointestinal stromal tumors, 5 sarcomas, and 3 head and neck cancer). Concerning app satisfaction, 70.4% (20/27) of patients found the app intuitive and easy to use, and 51.9% (17/27) of them said that the app helped them to improve and handle their problems better. Overall, 17 out of 27 patients [62.9%] were satisfied with the app, and 14 of them [51.8%] would recommend the app to other patients.ConclusionsWe observed that the app’s acceptability and satisfaction were good, which is essential for the continuity of the project. In the subsequent phases, we will develop predictive models based on the collected information during this phase. We will validate the method and analyze the sensitivity of the automated results.

The feasibility and acceptability of using smartphones to assess suicide risk among Spanish-speaking adult outpatients.

Hispanic/Latino adults, particularly Spanish speakers, are underserved in mental healthcare, and little is known about the day-to-day variation in their suicide risk. Smartphones have the potential to overcome geographical and linguistic barriers to mental health assessment and intervention. The purpose of the current study was to examine (a) the feasibility/acceptability of smartphone-based ecological momentary assessment (EMA) to assess suicide ideation and suicide risk factors among high-risk Spanish-speaking adults and (b) the degree of within-person variation of suicide ideation and suicide risk in this population. Sixteen primary Spanish-speaking psychiatry outpatients completed EMA measures of suicide ideation and suicide risk factors four times a day for 14 days. A majority of participants consented to active and passive remote assessments and reported the acceptability of study procedures. Adherence to EMA was high and not associated with symptom severity. EMA instances completed were not associated with symptom severity at follow-up. Average point-to-point variability in suicide ideation and risk factors were moderate to high, respectively. EMA captured more dramatic changes than standard baseline and follow-up assessments. Results provide preliminary support for the feasibility and acceptability of using smartphones to assess suicide risk in a real-time and real-world setting among high-risk Spanish-speaking adults.

A Proof-of-Concept Ecological Momentary Assessment Study of Day-Level Dynamics in Value-Based Decision-Making in Opioid Addiction.

BackgroundDrug addiction is thought to be characterized by risky and impulsive behavior despite harmful consequences. Whether these aspects of value-based decision-making in people with addiction are stable and trait-like, and the degree to which they vary within-person and are sensitive to changes in psychological state, remains unknown. In this pilot study, we examined the feasibility of distinguishing these state- vs. trait-like components by probing day-level dynamics of risk and time preferences in patients with opioid use disorder (OUD) as they engaged with their natural environment.MethodsTwenty-three individuals with OUD receiving outpatient treatment (40% female; M = 45.67 [SD = 13.16] years of age) and twenty-one matched healthy community controls (47% female; M = 49.67 [SD = 14.38] years of age) participated in a 28-day smartphone-based ecological momentary assessment study (1085 person days; M = 24.66, SD = 5.84). Random prompts administered daily assessed subjects’ psychological state (e.g., mood) and economic preferences for real delayed and risky monetary rewards.ResultsSubjects demonstrated dynamic decision-making preferences, with 40–53% of the variation in known risk and ambiguity tolerance, and 67% in discounting, attributable to between-person vs. within-person (day-to-day) differences. We found that changes in psychological state were related to changes in risk preferences, with patients preferring riskier offers on days they reported being in a better mood but no differences between groups in aggregate level behavior. By contrast, temporal discounting was increased overall in patients compared to controls and was unrelated to global mood. The study was well-tolerated, but compliance rates were moderate and lower in patients.ConclusionOur data support the idea that decision-making preferences in drug addiction exhibit substantial within-person variability and that this variability can be well-captured using remote data collection methods. Preliminary findings suggested that aspects of decision-making related to consideration of risk may be more sensitive to within-person change in global psychological state while those related to consideration of delay to reward, despite also being somewhat variable, stably differ from healthy levels. Identifying the cognitive factors that contribute to opioid use risk in a “real-world” setting may be important for identifying unique, time-sensitive targets for intervention.

Smartphone-Based Ecological Momentary Assessment of Coping with Loneliness amid COVID-19 in Germany

The COVID-19 pandemic may have caused people to feel isolated, left out, and in need of companionship. Effective strategies to cope with such unrelenting feelings of loneliness are needed. In times of COVID-19, we conducted a smartphone-based ecological momentary assessment (EMA) study with 280 lonely participants in Germany over 7 months, where a long and hard second national lockdown was in place. Each participant reported their daily loneliness and coping strategies for loneliness once in the evening for 7 consecutive days. We found that managing emotions and social relationships were associated with decreased feelings of loneliness, while using a problem-focused coping strategy was associated with increased feelings of loneliness amid COVID-19. Interestingly, managing emotions was particularly effective for easing loneliness during the second lockdown. Females tend to use more emotion-focused coping strategies to overcome their loneliness compared to males. Our study highlights the importance of managing emotions against loneliness throughout the COVID-19 pandemic in Germany. Designing technology that provides emotional support to people may be one of the keys to easing loneliness and promoting well-being.