Experience sampling methodology in mental health research: new insights and technical developments

The relationship between stress and clinical high-risk symptoms of psychosis in daily life: impact of contemporaneous paths on cross-lagged effects

BACKGROUND

This study aimed to deepen the understanding of the psychological mechanisms underlying the formation and maintenance of clinical high-risk symptoms for psychosis (CHR-P) in real-life contexts. Specifically, it examined whether (i) momentary feelings of stress increase the frequency of CHR-P symptoms, or conversely, (ii) CHR-P symptoms increase the intensity of stress. Additionally, potential moderators of the relationship between stress and CHR-P symptoms were explored.

METHODS

Using Ecological Momentary Assessment, 79 patients (age: 11-36; 50.6% female) recruited from an early detection center for psychosis, reported their momentary stress levels and the frequency of CHR-P symptoms eight times a day for seven days. Time series data were analyzed using residual dynamic structural equation modeling in a random intercept cross-lagged panel design, comparing differently modeled contemporaneous effects.

RESULTS

There was no evidence of a contemporaneous or temporal link between stress on CHR-P symptoms. However, a contemporaneous effect of CHR-P symptoms on stress was found, while the corresponding temporal effect was not significant. The severity of interview-assessed CHR-P symptoms, age, and type of CHR-P symptoms (i.e., basic symptoms vs. [attenuated] positive symptoms) did not affect the contemporaneous effect of CHR-P symptoms on stress. However, nonperceptive symptoms had a greater contemporaneous effect on stress than perceptive symptoms.

CONCLUSIONS

The findings suggest a greater contemporaneous impact of CHR-P symptoms on stress than vice versa. The experience of nonperceptive symptoms, in particular, may alter the appraisal of stress in daily life and represent a target for early interventions in real-time daily life (i.e., ecological momentary interventions).

Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis

Background

Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice.

Objective

Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy.

Methods

Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants' prior knowledge and expectations, actual use in practice, and potential future use of ESM tools.

Results

Many participants experienced that the ESM tool provided useful information about clients' mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future.

Conclusions

Clinicians' and clients' choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters.

Why are adolescent girls more prone to stress-induced depression? Testing moderation, mediation, and reciprocal causality in a three-wave longitudinal study

The prevalence of depression in females after puberty is twice as high as in their male peers. Considering numerous studies that associate the onset of depression with stress, we tested three hypotheses to elucidate the role of biological sex in stress-induced depression on a sample of 1618 secondary school students from Zagreb, Croatia (Males, N = 671, Mage at baseline = 16.4 years, SD = 0.60; Females, N = 947, Mage at baseline = 16.3 years, SD = 0.65), in a three-wave longitudinal study. The study tested the hypotheses regarding: (a) sex-related differences in reciprocal causation of stress and depression, (b) the moderating role of biological sex in the effect of stress on depression, and (c) the mediating role of stress on the pathway from biological sex to depression. The data were analyzed using a random intercept cross-lagged panel model (RI-CLPM) and standard moderation and mediation analyses. Females consistently reported higher levels of stress (Cohen's d ranged from 0.76 to 0.83) and depression (0.59 to 0.69) compared with their male peers. The hypothesis that biological sex moderates the effect of stress on depression was not supported, as the interaction between sex and subjective stress was mostly nonsignificant or small in magnitude, with standardized regression coefficients not exceeding .126. The hypothesis of sex-differentiated reciprocal causation of stress and depression was also not supported since cross-lagged relations were found to be mostly nonsignificant, indicating that the association between stress and depression rests largely on stable dispositions. The data supported the hypothesis of stress mediating the effect of biological sex on depression, with indirect effects ranging from 0.23 to 0.25 (95% CI 0.19 to 0.30). The findings suggest that the increased vulnerability of adolescent girls may lie in stable dispositions possibly responsible for higher sensitivity and less effective coping with stressful situations that lead to depression.

Exploring the implementation of a novel, transdiagnostic, hybrid ecological momentary intervention for improving resilience in youth (EMIcompass): A process evaluation in the realist framework

OBJECTIVES

Previous research indicates that the hybrid compassion-focused intervention EMIcompass may reduce stress reactivity and improve quality of life. Our aim was to investigate what components of the intervention work for whom, how, and under which circumstances to contribute to the enhancement of resilience.

METHODS

We conducted a process evaluation using a realist framework. First, we developed initial programme theories using compassion-focused interventions and ecological momentary intervention documents, in addition to conducting a focus group and an interview with an individual expert. Second, we tested the initial programme theories based on qualitative data from 20 participants. Third, we refined the programme theories by analysing and interpreting the data.

RESULTS

We identified four programme components experienced as enhancing the activation of the soothing system and the application of compassion-focused principles. EMIcompass was perceived as lowering the burden of and barriers to treatment and facilitating the translation into daily life. Intra- and interpersonal context factors interacted with the mechanisms, leading to improvement in well-being, which was identified as a main outcome.

DISCUSSION

The intervention worked by strengthening participants' soothing system and facilitating ecological translation leading to improved well-being. Adaptions to improve the intervention may allow for more flexibility in individual intervention trajectories acknowledging different needs and preferences.

Who thrives in a public health crisis?

Public health emergencies such as the COVID-19 pandemic pose daunting challenges to both policymakers and citizens. Social distancing measures have been found to adversely impact mental health. In this study, we sought to identify those who thrived throughout the worst wave of the COVID-19 pandemic in Hong Kong. We used a 30-day diary dataset that captured the daily hopefulness ratings of 611 participants (15,575 observations) together with their Big Five personality scores. Hopefulness scores remained stable throughout the enforcement and lifting of social distancing. Individuals who were emotionally stable, extraverted, open to experience, and conscientious felt hopeful overall. In contrast, agreeable individuals, who tend to hold a positive view of human nature, did not feel hopeful during the 30-day period. Our findings suggest that people with agreeable and positive traits do not retain their hopefulness during an actual health crisis and might be at risk of poor mental health, suggesting the need for intervention.

The Effect of Different Construct Operationalizations, Study Duration, and Preprocessing Choices on Power-Based Sample Size Recommendations in Intensive Longitudinal Research

To shed light on the dynamics of psychological processes, researchers often collect intensive longitudinal (IL) data by asking people to repeatedly report on their momentary experiences in daily life. Two important decisions when designing an IL study concern the number of persons and the number of measurement occasions to be included. These sample size decisions are ideally based on statistical power considerations. When conducting statistical power analysis, it is necessary to provide the value of the effect size of interest as well as of all other model parameters. In IL research, these values have to be based on previous studies. This implies that these values are subject to large heterogeneity due to differences in study design and preprocessing choices. This between-study heterogeneity can severely impact power-based sample size recommendations. In this article, we introduce an approach to investigate the impact of study design and pre-processing of previous studies and to determine a recommended sample size to account for this impact. We demonstrate how to use this approach to investigate the effect of different construct operationalizations, study duration, and preprocessing choices. This approach paves the way for more thoughtful and robust sample-size decisions.

A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms

BACKGROUND

Symptoms of complex post-traumatic stress disorder (cPTSD) may play a role in the maintenance of psychotic symptoms. Network analyses have shown interrelationships between post-traumatic sequelae and psychosis, but the temporal dynamics of these relationships in people with psychosis and a history of trauma remain unclear. We aimed to explore, using network analysis, the temporal order of relationships between symptoms of cPTSD (i.e. core PTSD and disturbances of self-organization [DSOs]) and psychosis in the flow of daily life.

METHODS

Participants with psychosis and comorbid PTSD (N = 153) completed an experience-sampling study involving multiple daily assessments of psychosis (paranoia, voices, and visions), core PTSD (trauma-related intrusions, avoidance, hyperarousal), and DSOs (emotional dysregulation, interpersonal difficulties, negative self-concept) over six consecutive days. Multilevel vector autoregressive modeling was used to estimate three complementary networks representing different timescales.

RESULTS

Our between-subjects network suggested that, on average over the testing period, most cPTSD symptoms related to at least one positive psychotic symptom. Many average relationships persist in the contemporaneous network, indicating symptoms of cPTSD and psychosis co-occur, especially paranoia with hyperarousal and negative self-concept. The temporal network suggested that paranoia reciprocally predicted, and was predicted by, hyperarousal, negative self-concept, and emotional dysregulation from moment to moment. cPTSD did not directly relate to voices in the temporal network.

CONCLUSIONS

cPTSD and positive psychosis symptoms mutually maintain each other in trauma-exposed people with psychosis via the maintenance of current threat, consistent with cognitive models of PTSD. Current threat, therefore, represents a valuable treatment target in phased-based trauma-focused psychosis interventions.

A systematic review of studies using network analysis to assess dynamics of psychotic-like experiences in community samples

Several studies have used a network analysis to recognize the dynamics and determinants of psychotic-like experiences (PLEs) in community samples. Their synthesis has not been provided so far. A systematic review of studies using a network analysis to assess the dynamics of PLEs in community samples was performed. Altogether, 27 studies were included. The overall percentage ranks of centrality metrics for PLEs were 23.5% for strength (20 studies), 26.0% for betweenness (5 studies), 29.7% for closeness (6 studies), 26.9% for expected influence (7 studies), and 29.1% for bridge expected influence (3 studies). Included studies covered three topics: phenomenology of PLEs and associated symptom domains (14 studies), exposure to stress and PLEs (7 studies), and PLEs with respect to suicide-related outcomes (6 studies). Several other symptom domains were directly connected to PLEs. A total of 6 studies investigated PLEs with respect to childhood trauma (CT) history. These studies demonstrated that PLEs are directly connected to CT history (4 studies) or a cumulative measure of environmental exposures (1 study). Moreover, CT was found to moderate the association of PLEs with other symptom domains (1 study). Two studies that revealed direct connections of CT with PLEs also found potential mediating effects of cognitive biases and general psychopathology. PLEs were also directly connected to suicide-related outcomes across all studies included within this topic. The findings imply that PLEs are transdiagnostic phenomena that do not represent the most central domain of psychopathology in community samples. Their occurrence might be associated with CT and suicide risk.

Self-criticism is a real-time predictor of non-suicidal self-injury and disordered eating: An ecological momentary assessment study among treatment-seeking individuals

BACKGROUND

Although theory and research implicate self-criticism as a risk factor for non-suicidal self-injury (NSSI), the nature of this association in daily life remains unclear. This study used ecological momentary assessment (EMA) to address whether (1) trait and state self-criticism elevate the risk of NSSI, (2) state self-criticism predicts NSSI behavior in real-time via increased NSSI urge intensity, and (3) the risk pattern extends to disordered eating (DE; binge eating, purging, restrictive eating).

METHODS

A total of 125 treatment-seeking individuals who self-injure (87.20% female; Mage = 22.98, SD = 5.32) completed measures of trait self-criticism at intake, followed by six daily assessments for 28 days (15,098 assessments; median compliance = 78.6%) measuring self-critical thoughts, NSSI, and DE. Multilevel vector autoregressive models were constructed within a dynamic structural equation modeling framework.

RESULTS

Patients who reported higher mean state self-critical thoughts experienced more intense NSSI urges and an increased risk for NSSI behavior during the 28-day EMA period. Higher-than-usual self-critical thoughts predicted NSSI urge intensity and NSSI behavior within the following 2 h. NSSI urge intensity partially mediated the effect of self-critical thoughts on NSSI behavior. Trait self-criticism did not predict comorbid DE, but mean state self-critical thoughts were associated with binge eating and restrictive eating. The within-person risk pattern of self-criticism generally extended to DE, with full mediation via DE urges for purging and restrictive eating, but not binge eating.

CONCLUSIONS

Self-criticism is a real-time predictor of NSSI and comorbid DE. These findings underscore the relevance of monitoring self-criticism outside the therapy room, as it may be an important treatment target.

The use of Experience Sampling Method in psychopharmacological studies: A systematic review

The Experience Sampling Method (ESM) is increasingly used to validate and assess treatment effects. We conducted a systematic review to update, and extend, the previous review by Bos et al. (2015), by performing literature searches in PubMed, PsycInfo, and EMBASE. Search queries included every DSM-disorder, ATC-listed psychotropic medication, and multiple search-terms for ESM. Studies included medicated psychiatric patients who filled-out ambulatory prompts ≥2/day. Templates served to distil research themes. The majority of the 79 included studies involved substance use- (n = 47), mood- (n = 17), and psychotic disorders (n = 11). Less studied were anxiety disorders and PTSD (n = 3), and ADHD (n = 1). We identified six research themes:1)Effects of psychopharmacological treatment on symptoms and factors influencing outcome, 2)Fluctuations of psychiatric symptoms in medicated patients, 3)Prediction of relapse, exacerbation of symptoms or medication non-compliance, 4)Added value of ESM compared to care as usual, 5)Using ESM to establish treatment response-trajectories, 6)Acceptability and feasibility of newly-devised ESM-applications. This review reveals that ESM is predominantly used in psychopharmacological studies to monitor treatment effects and establish fluctuations of momentary psychiatric symptoms. Future research might facilitate personalising psychopharmacological prescribing decisions using ESM. Currently underrepresented patient groups include elderly patients, and personality disorders. Finally, to facilitate ESM-implementation multiple context-levels should be optimised.

The potential of experience sampling methods in palliative care

BACKGROUND

Experience sampling methods typically involve multiple self-report assessments per day over consecutive days. Unlike traditional patient-reported outcome measures or interviews, such methods offer the possibility to capture the temporal fluctuations of experiences in daily environments, making them valuable for studying the daily lives of people with advanced illness. Yet, their use in palliative care research is limited.

AIMS

To introduce experience sampling methods to the field of palliative care as a valuable tool for studying the everyday experiences of people with advanced illness, and to present the findings of an experience sampling methods pilot study with people with advanced breast or advanced lung cancer.

EVIDENCE USED TO SUPPORT THE INFORMATION PRESENTED

We draw on published health research using experience sampling methods. We present a newly developed experience sampling methods questionnaire (ESM-AC) and report pilot study findings on the feasibility and acceptability of experience sampling methods among people with advanced breast or lung cancer.

KEY LEARNING POINTS

Experience sampling methods hold potential to uncover the dynamics of everyday experiences of people with advanced illness. The methods offer considerable flexibility and options to answer a variety of research questions, but consideration is required regarding sampling protocols and participant burden. We showed appropriate feasibility and acceptable participant burden of the methods among people with advanced breast or advanced lung cancer.

Return of negative interpretation bias after positive interpretation training as a dynamic predictor of treatment outcome in fear of public speaking

Despite various efforts in the field, no consistent predictors of treatment outcome in anxiety disorders have been identified. Based on the Dynamic System Theory, this study proposes a novel, dynamic predictor of treatment outcome in those with public speaking anxiety. It was assessed whether speed of return to one's interpretation bias equilibrium after an experimentally-induced perturbation (i.e., interpretation training targeting negative interpretation bias as a critical maintaining factor for anxiety) predicts subsequent outcome to online exposure treatment. Women with subclinical public speaking anxiety (N = 100, M age = 23.13, SD = 3.89) were randomly allocated to a positive interpretation training (n = 50) or a neutral interpretation training (n = 50). Dynamic changes in negative interpretations were measured using Experience Sampling Method. Later, participants followed an online one-session exposure therapy for public speaking anxiety. Positive interpretation training resulted in a stronger reduction in negative interpretations compared to the neutral interpretation training. Fear of public speaking decreased from before to after the exposure therapy. Consistent with our central hypothesis, results showed that slower return to one's interpretation bias equilibrium after the positive interpretation training was associated with a greater decline in fear of public speaking after exposure treatment. These results show the potential of a dynamic approach in predicting treatment outcome in public speaking anxiety. This study contributes to the field of clinical psychology, as finding more reliable predictors of treatment outcome before the start of therapy could contribute to the efficiency of care delivery.

Modelling the impact of environmental and social determinants on mental health using generative agents

Mental health is shaped by socio-environmental determinants, yet traditional research approaches struggle to capture their complex interactions. This review explores the potential of generative agents, powered by large language models, to simulate human-like behaviour in virtual environments for mental health research. We outline potential applications including the modelling of adverse life events, urbanicity, climate change, discuss potential challenges and describe how generative agents could transform mental health research.

Understanding tinnitus symptom dynamics and clinical improvement through intensive longitudinal data

Intensive longitudinal sampling enhances subjective data collection by capturing real-time, dynamic inputs in natural settings, complementing traditional methods. This study evaluates the feasibility of using daily self-reported app data to assess clinical improvement among tinnitus patients undergoing treatment. App data from a multi-center randomized clinical trial were analysed using time-series feature extraction and nested cross-validated ordinal regression with elastic net regulation to predict clinical improvement based on the Clinical Global Impression-Improvement scale (CGI-I). With 50% app compliance (N = 129, 8480 entries), the model demonstrated good fit to the test data (McFadden R2 = 0.82) suggesting its generalizability. Clinical improvement was associated with linear declines in tinnitus-related thoughts, jaw tension, tinnitus loudness, increases in happiness, and variability changes in tinnitus loudness and distress. These findings suggest that daily self-reported data on tinnitus symptoms is sensitive to treatment response and provides insights into specific symptom changes that occur during treatment.

Network intervention analysis to assess the trajectory of change and intervention effects associated with the use of self-control training for ego depletion aftereffects

PURPOSE

The purpose of this study was to use the advanced technique of Network Intervention Analysis (NIA) to investigate the trajectory of symptom change associated with the effects of self-control training on youth university students' chronic ego depletion aftereffects.

METHODS

The nine nodes of chronic ego depletion aftereffects and integrated self-control training were taken as nodes in the network and analyzed using NIA. Networks were computed at the baseline, at the end of treatment, at 1-, 3-, 6-, 9- and 12-month follow up. 62 samples were recruited from universities and randomly divided into two groups. The sample ranged in age from 18 to 25 years and included both males and females.

RESULTS

Self-control training interventions directly improved the states of low self-efficacy, low adherence, and work burnout, as well as indirectly alleviated fatigue, emotional regulation disorders, and other issues. Follow-up surveys showed that the intervention not only had immediate effects but also had long-term effects.

CONCLUSION

These findings indicate that self-control training has a direct intervention effect on low self-efficacy, low adherence, and work burnout of youth university students' ego depletion aftereffects. This study is the first application of NIA in abnormal psychological state intervention research outside the field of mental disorder treatment. NIA is a promising method to evaluate the trajectories of intervention change and the direct and indirect effects of training interventions.

CLINICAL TRIAL REGISTRATION

No. KY20202063-F-2; date of approval: 10th December, 2020.

Translational assessment of anhedonia components: Significant associations between reward anticipation measured via behavioural task performance, daily smartphone reports, and general anhedonia questionnaires

Anhedonia, a reduction in pleasure in previously enjoyed activities, is a hallmark feature of depression and is also of transdiagnostic relevance to many psychiatric disorders. Treatment and measurement of anhedonia are significant challenges. We examine anhedonia components, combining experimental training, with multimodal anhedonia assessment, comprising standard questionnaire instruments, a widely-used behavioural task, and daily reports of reward experience. Seventy-eight adults (74.4% female) completed both positive and negative cognitive bias modification training, a laboratory-based behavioural measure of reward anticipation and motivation, the Effort-Expenditure for Reward Task (EEfRT), and seven days of experience sampling via their smartphones. We found no evidence that cognitive bias modification training affected choices to engage in the high-effort trials on the EEfRT task, theorised to reflect reward anticipation. We also did not find the expected associations between baseline measures of anhedonia and reward sensitivity and response to training. Behavioural performance on the low probability EEfRT trials indicating higher reward anticipation was significantly associated with daily reports of anticipated reward. Daily reported reward anticipation and consumption were also associated with the questionnaire measure of anhedonia. Our findings demonstrate that traditional anhedonia questionnaire measures, and a laboratory-based measure of an anhedonia component, can translate to reported experiences of reward in real-world contexts. We demonstrate the specificity of associations between the laboratory measure, designed to measure reward anticipation and not consumption, and real-world reports.

Suitability of the DSM-5 social anxiety disorder severity scale for autistic adults

LAY ABSTRACT

Mental health measures used with autistic adults are often only evaluated for use with non-autistic adults, which may cause inaccurate measurement. This is important when measuring social anxiety disorder as some features overlap with social characteristics of autism. This study evaluated one self-report questionnaire measure of social anxiety disorder, the Severity Measure for Social Anxiety Disorder. The Severity Measure for Social Anxiety Disorder is based upon criteria for diagnosis of social anxiety disorder, and we aimed to understand its suitability for autistic adults. The Severity Measure for Social Anxiety Disorder was completed by 284 autistic adults and 80 non-autistic adults who were then asked five follow-up questions about ambiguous questions on the Severity Measure for Social Anxiety Disorder. We found that over half our sample of autistic adults, on at least one question, attributed their answer to something other than anxiety. Furthermore, in autistic adults, one underlying construct of social anxiety did not link their answers on the Severity Measure for Social Anxiety Disorder together, suggesting the Severity Measure for Social Anxiety Disorder might not be suited to capturing social anxiety disorder in autistic adults. To improve measurement, we rescored answers where participants said their response was due to something other than social anxiety, however, the rescored Severity Measure for Social Anxiety Disorder did not only capture social anxiety in autistic adults either. Finally, we analysed the reasons other than social anxiety autistic adults said influenced their answers. We grouped their responses into 10 categories, for example, 'fatigue', 'sensory overwhelm', and 'masking'. Overall, our findings suggest caution when using the Severity Measure for Social Anxiety Disorder with autistic adults, and the categories identified may suggest how to measure social anxiety more accurately in autistic adults.

What Makes for a Vitalizing Day in Adolescence? Antecedents and Outcomes of Daily Need Crafting

Psychological need crafting denotes individuals' pro-active attempts to fulfill their psychological need for autonomy, relatedness, and competence. Although previous research has shown that need crafting contributes to adolescents' mental health, little is known about the factors involved in adolescents' daily efforts to engage in need crafting. This study considers psychological energy as both an important prerequisite for need crafting and as an outcome of daily need crafting. The sample consisted of 168 adolescents, aged 16-18 years (Mage = 16.63; 76.1% female). Morning and evening measurements were completed for 7 consecutive days. Adolescents' need crafting intentions in the morning were associated positively with vitality at the end of the day, an effect occurring through satisfaction of the basic psychological needs. Further, better sleep and subsequent morning vitality predicted more need crafting intentions in the morning. The findings indicate that both a psychological pathway (i.e., need crafting) and physical pathway (i.e., sleep) are critical to preserve adolescents' daily vitality.

A Gentle Introduction and Application of Feature-Based Clustering with Psychological Time Series

Psychological researchers and practitioners collect increasingly complex time series data aimed at identifying differences between the developments of participants or patients. Past research has proposed a number of dynamic measures that describe meaningful developmental patterns for psychological data (e.g., instability, inertia, linear trend). Yet, commonly used clustering approaches are often not able to include these meaningful measures (e.g., due to model assumptions). We propose feature-based time series clustering as a flexible, transparent, and well-grounded approach that clusters participants based on the dynamic measures directly using common clustering algorithms. We introduce the approach and illustrate the utility of the method with real-world empirical data that highlight common ESM challenges of multivariate conceptualizations, structural missingness, and non-stationary trends. We use the data to showcase the main steps of input selection, feature extraction, feature reduction, feature clustering, and cluster evaluation. We also provide practical algorithm overviews and readily available code for data preparation, analysis, and interpretation.

Ecological Momentary Assessment of Mental Health Problems Among University Students: Data Quality Evaluation Study

BACKGROUND

The use of ecological momentary assessment (EMA) designs has been on the rise in mental health epidemiology. However, there is a lack of knowledge of the determinants of participation in and compliance with EMA studies, reliability of measures, and underreporting of methodological details and data quality indicators.

OBJECTIVE

This study aims to evaluate the quality of EMA data in a large sample of university students by estimating participation rate and mean compliance, identifying predictors of individual-level participation and compliance, evaluating between- and within-person reliability of measures of negative and positive affect, and identifying potential careless responding.

METHODS

A total of 1259 university students were invited to participate in a 15-day EMA study on mental health problems. Logistic and Poisson regressions were used to investigate the associations between sociodemographic factors, lifetime adverse experiences, stressful events in the previous 12 months, and mental disorder screens and EMA participation and compliance. Multilevel reliability and intraclass correlation coefficients were obtained for positive and negative affect measures. Careless responders were identified based on low compliance or individual reliability coefficients.

RESULTS

Of those invited, 62.1% (782/1259) participated in the EMA study, with a mean compliance of 76.9% (SD 27.7%). Participation was higher among female individuals (odds ratio [OR] 1.41, 95% CI 1.06-1.87) and lower among those aged ≥30 years (OR 0.20, 95% CI 0.08-0.43 vs those aged 18-21 years) and those who had experienced the death of a friend or family member in the previous 12 months (OR 0.73, 95% CI 0.57-0.94) or had a suicide attempt in the previous 12 months (OR 0.26, 95% CI 0.10-0.64). Compliance was particularly low among those exposed to sexual abuse before the age of 18 years (exponential of β=0.87) or to sexual assault or rape in the previous year (exponential of β=0.80) and among those with 12-month positive alcohol use disorder screens (exponential of β=0.89). Between-person reliability of negative and positive affect was strong (RkRn>0.97), whereas within-person reliability was fair to moderate (Rcn>0.43). Of all answered assessments, 0.86% (291/33,626) were flagged as careless responses because the response time per item was <1 second or the participants gave the same response to all items. Of the participants, 17.5% (137/782) could be considered careless responders due to low compliance (<25/56, 45%) or very low to null individual reliability (raw Cronbach α<0.11) for either negative or positive affect.

CONCLUSIONS

Data quality assessments should be carried out in EMA studies in a standardized manner to provide robust conclusions to advance the field. Future EMA research should implement strategies to mitigate nonresponse bias as well as conduct sensitivity analyses to assess possible exclusion of careless responders.

Examining the moderating role of depressive symptoms on the dynamic interplay between cognitive reappraisal and rumination: Evidence from experience sampling

The dynamic view of emotion regulation (ER) posits that ER is a temporally dynamic process unfolding over time. Cognitive reappraisal and rumination, two extensively investigated ER strategies, are implicated in depression. However, it remains unclear whether these two strategies exhibit reciprocal relations in real-world contexts, and whether such relations vary across baseline depressive symptoms. To address this, we conducted two experience sampling studies and applied residual dynamic structural equation modeling (RDSEM). Results of the RDSEM revealed significant bidirectional associations between cognitive reappraisal and rumination in the Chinese sample, whereas in the Belgian sample, only a unidirectional relationship was found where rumination predicts subsequent cognitive reappraisal. Additionally, both strategies demonstrated stable autoregressive effects. Interestingly, higher depressive symptoms predicted a lower autoregressive effect of cognitive reappraisal within the Chinese sample, while this was not the case in the Belgian sample. These findings highlight the importance of targeting factors such as dynamics in ER and its relationship with depression symptoms.

The Interaction of Polygenic Susceptibility to Stress and Childhood Adversity Dimensions Predicts Longitudinal Trajectories of Stress-Sensitivity

Stress-sensitivity (SS) is considered a psychobiological trait possibly resulting from the interaction of genetic and environmental factors (GxE). This study examined whether the interaction of SS-related genetic markers with interview-based dimensions of childhood adversity predicted longitudinal trajectories of low versus high SS. Participants were nonclinically-ascertained young adults comprising normative and elevated scores on schizotypy. SS trajectories were defined in a previous report based on three prospective assessments (23.5, 25, 28 years-old) of both retrospective (Perceived Stress Scale; PSS) and momentary (Experience Sampling Methodology; ESM) stress ratings. A total of n = 177 and n = 165 participants with PSS and ESM stress-sensitivity trajectories, respectively, as well as genetic data, were included in the study. GxE effects between a SS Polygenic Risk Score (PRS-SS) and a Genetic Risk Score of the Hypothalamic Pituitary Adrenal axis (GRS-HPA) with childhood adversity dimensions (Intrafamilial Adversity, Threat and Deprivation) on SS trajectories were examined. Threat was the most consistent predictor of persistently high SS. PRS-SS moderated the association of Threat with high-PSS. GRS-HPA moderated the effects of all adversity dimensions on high-PSS. The interaction of PRS-SS with Deprivation and GRS-HPA with Intrafamilial Adversity predicted trajectories of momentary social stress, but the effects were driven by those with lower genetic susceptibility. Genetic-HPA-axis moderates the effects of all adversity dimensions on persistent SS trajectories, as well as PRS-SS and Threat, particularly for retrospective stress measure. The findings highlight the complex interplay between GxE factors and suggest that PSS may better capture SS trait. Including biologically-meaningful GRS indexing SS and adversity dimensions in future studies using comprehensive stress measures would enhance our knowledge on high SS susceptibility and its relationship with diverse psychopathological outcomes.

A control theoretic approach to evaluate and inform ecological momentary interventions

OBJECTIVES

Ecological momentary interventions (EMI) are digital mobile health interventions administered in an individual's daily life to improve mental health by tailoring intervention components to person and context. Experience sampling via ecological momentary assessments (EMA) furthermore provides dynamic contextual information on an individual's mental health state. We propose a personalized data-driven generic framework to select and evaluate EMI based on EMA.

METHODS

We analyze EMA/EMI time-series from 10 individuals, published in a previous study. The EMA consist of multivariate psychological Likert scales. The EMI are mental health trainings presented on a smartphone. We model EMA as linear dynamical systems (DS) and EMI as perturbations. Using concepts from network control theory, we propose and evaluate three personalized data-driven intervention delivery strategies. Moreover, we study putative change mechanisms in response to interventions.

RESULTS

We identify promising intervention delivery strategies that outperform empirical strategies in simulation. We pinpoint interventions with a high positive impact on the network, at low energetic costs. Although mechanisms differ between individuals - demanding personalized solutions - the proposed strategies are generic and applicable to various real-world settings.

CONCLUSIONS

Combined with knowledge from mental health experts, DS and control algorithms may provide powerful data-driven and personalized intervention delivery and evaluation strategies.

Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial

BACKGROUND

Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands.

OBJECTIVE

This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis.

METHODS

In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes.

RESULTS

Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=-4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=-0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=-1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app.

CONCLUSIONS

Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization.

TRIAL REGISTRATION

OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803.

Temporal interaction of suicidal ideations and behaviors with loneliness in persistent depressive disorder - a feasibility study using ecological momentary assessment

Individuals with persistent depressive disorder (PDD) are at increased risk for suicidality. Suicidality may be precipitated by loneliness. However, their temporal interplay in PDD has not been studied. We conducted a feasibility study using ecological momentary assessment (EMA) to measure short-term courses of suicidality and loneliness in 20 inpatients with PDD and current suicidality. EMA adherence of 13 completers was 81.3%. Suicidal ideations and loneliness varied with one standard deviation over three to six hours. This pilot study confirmed the feasibility of EMA in PDD and provided new insights in dynamics of suicidality and loneliness informing future study designs.

A systematic review of interpersonal processes and their measurement within experience sampling studies of self-injurious thoughts and behaviours

Self-injurious thoughts and behaviours (SITBs) are a leading cause of death, and interpersonal processes (IPs) appear to play a role in SITBs. This systematic review synthesises the literature on IPs and SITBs in daily life and addresses four critical questions: (1) Which IPs have been assessed and how, (2) How are differences in IPs between individuals associated with SITBs?, (3) How are differences in IPs within individuals associated with SITBs? and (4) Do IPs relate differently to self-injurious thoughts than behaviours? Our review followed PRISMA guidelines and eligible literature was screened until 25 April 2024. We identified 58 Experience Sampling studies (32.76% daily-diary studies) of which most focused on IPs from major SITBs theories (e.g., thwarted belongingness) but largely used inconsistent operationalizations. Results from 39 studies investigating within-person associations were mixed. Based on 26 studies, whether differences in IPs between individuals relate to SITBs remains unclear. Three studies have investigated whether IPs relate to the transition from thoughts to behaviours, but temporal models are needed to draw firm conclusions. Studies investigating IPs and SITBs in daily life are largely inconclusive. Psychometrically validated measures are warranted, and future daily-life studies would benefit from drawing on ideation-to-action frameworks.

Looking for the good in times of adversity: Examining the interplay of temperament and social schemas in shaping resilience in youth

AIM

Resilience is a broad and dynamic concept that can be seen as being constituted by the combination of internal factors, for example, temperament profiles, and external factors, for example, social support. This paper aimed to identify temperament profiles in help-seeking youth exposed to adverse childhood experiences, and to investigate whether temperament (putative internal protective factor) interacts with social schemas (as proxy for the putative external protective factor social support) such that their combination is associated with (a) reduced mental health problems and (b) attenuated decrease in positive affect following daily life stressors.

METHODS

Self-report questionnaires were used to measure temperament, social schemas and mental health problems. The experience sampling method was used to assess stress and positive affect (i.e., stress-sensitivity as a potential daily life resilience mechanism). Temperament profiles were identified by latent profile analysis and regression analyses were used to examine (interaction) effects.

RESULTS

In 138 subjects, three temperament profiles were identified, that is, a moderate, volatile and persevering profile, of which the latter was negatively associated with mental health problems. Neither mental health problems nor stress sensitivity were found to be affected by the interaction between temperament and social schemas. However, positive social schemas were found to be independently associated with reduced mental health problems (b = -4.41; p = <.001) and reduced stress sensitivity (b = .10, p = .044).

CONCLUSIONS

Findings are relevant for both practice and research, and contribute to improving our understanding of putative protective factor in the development of mental ill-health, thereby further unravelling the construct of resilience.

Does social isolation predict the emergence of psychotic-like experiences? Results from the experience sampling method study

BACKGROUND

Several studies have shown that social isolation and loneliness are associated with the occurrence of psychotic experiences. However, dynamics of these phenomena in people with subclinical experiences, commonly referred to as psychotic-like experiences (PLEs), remains largely unknown. Therefore, in this study we performed a temporal network analysis to model dynamic predictions between social isolation, loneliness, negative affect, social stress, and PLEs.

METHODS

A total of 77 drug-naïve individuals with PLEs from a transdiagnostic sample were enrolled. Data were obtained using the experience sampling method (ESM). The ESM questionnaires were delivered during 7 consecutive days (6 assessments per day). Therefore, 3234 data entries were analyzed.

RESULTS

Social isolation predicted next-moment emergence of PLEs through the effects on loneliness and negative affect. Also, PLEs appeared to predict next-moment loneliness, but not social isolation, through the effects on negative affect. Social stress did not predict any variables in the network. However, it was predicted by previous-moment PLEs and social isolation. Negative affect had the highest in-strength and out-strength centrality.

CONCLUSIONS

Findings from the present study indicate that social isolation might predict the emergence of PLEs through the effects of momentary loneliness and negative affect. Also, loneliness might be bidirectionally associated with PLEs. Interventions targeting negative affect and social isolation might be beneficial in people with PLEs.

Social processes as the missing link: cross-sectionally testing a conceptual model on social mediators of early psychopathological development

BACKGROUND

Research suggests that most mental health conditions have their onset in the critically social period of adolescence. Yet, we lack understanding of the potential social processes underlying early psychopathological development. We propose a conceptual model where daily-life social interactions and social skills form an intermediate link between known risk and protective factors (adverse childhood experiences, bullying, social support, maladaptive parenting) and psychopathology in adolescents - that is explored using cross-sectional data.

METHODS

N = 1913 Flemish adolescent participants (Mean age = 13.8; 63% girls) were assessed as part of the SIGMA study, a large-scale, accelerated longitudinal study of adolescent mental health and development. Self-report questionnaires (on risk/protective factors, social skills, and psychopathology) were completed during class time; daily-life social interactions were measured during a subsequent six-day experience-sampling period.

RESULTS

Registered uncorrected multilevel linear regression results revealed significant associations between all risk/protective factors and psychopathology, between all risk/protective factors and social processes, and between all social processes and psychopathology. Social processes (social skills, quantity/quality of daily social interactions) were uniquely predicted by each risk/protective factor and were uniquely associated with both general and specific types of psychopathology. For older participants, some relationships between social processes and psychopathology were stronger.

CONCLUSIONS

Unique associations between risk/protective factors and psychopathology signify the distinct relevance of these factors for youth mental health, whereas the broad associations with social processes support these processes as broad correlates. Results align with the idea of a social pathway toward early psychopathology, although follow-up longitudinal research is required to verify any mediation effect.

Using Biosensor Devices and Ecological Momentary Assessment to Measure Emotion Regulation Processes: Pilot Observational Study With Dialectical Behavior Therapy

Background

Novel technologies, such as ecological momentary assessment (EMA) and wearable biosensor wristwatches, are increasingly being used to assess outcomes and mechanisms of change in psychological treatments. However, there is still a dearth of information on the feasibility and acceptability of these technologies and whether they can be reliably used to measure variables of interest.

Objective

Our objectives were to assess the feasibility and acceptability of incorporating these technologies into dialectical behavior therapy and conduct a pilot evaluation of whether these technologies can be used to assess emotion regulation processes and associated problems over the course of treatment.

Methods

A total of 20 adults with borderline personality disorder were enrolled in a 6-month course of dialectical behavior therapy. For 1 week out of every treatment month, participants were asked to complete EMA 6 times a day and to wear a biosensor watch. Each EMA assessment included measures of several negative affect and suicidal thinking, among other items. We used multilevel correlations to assess the contemporaneous association between electrodermal activity and 11 negative emotional states reported via EMA. A multilevel regression was conducted in which changes in composite ratings of suicidal thinking were regressed onto changes in negative affect.

Results

On average, participants completed 54.39% (SD 33.1%) of all EMA (range 4.7%-92.4%). They also wore the device for an average of 9.52 (SD 6.47) hours per day and for 92.6% of all days. Importantly, no associations were found between emotional state and electrodermal activity, whether examining a composite of all high-arousal negative emotions or individual emotional states (within-person r ranged from -0.026 to -0.109). Smaller changes in negative affect composite scores were associated with greater suicidal thinking ratings at the subsequent timepoint, beyond the effect of suicidal thinking at the initial timepoint.

Conclusions

Results indicated moderate overall compliance with EMA and wearing the watch; however, there was no concurrence between EMA and wristwatch data on emotions. This pilot study raises questions about the reliability and validity of these technologies incorporated into treatment studies to evaluate emotion regulation mechanisms.

Understanding irritability through the lens of self-regulatory control processes in children and adolescents: a systematic review

Among youths, pathological irritability is highly prevalent and severely disabling. As a frequent symptom, it often leads to referrals to child and adolescent mental health services. Self-regulatory control (SRC) processes are a set of socio-psycho-physiological processes that allow individuals to adapt to their ever-changing environments. This conceptual framework may enhance the current understanding of the cognitive, emotional, behavioural and social dysregulations underlying irritability. The present systematic review (PROSPERO registration: #CRD42022370390) aims to synthesize existing studies that examine irritability through the lens of SRC processes among youths (< 18 years of age). We conducted a comprehensive literature search among six bibliographic databases: Embase.com, Medline ALL Ovid, APA PsycInfo Ovid, Web of Science Core Collection, the Cochrane Database of Systematic Reviews Wiley and ProQuest Dissertations & Theses A&I. Additional searches were performed using citation tracing strategies. The retrieved reports totalled 2612, of which we included 82 (i.e., articles) from 74 studies. More than 85% of reports were published during the last 6 years, highlighting the topicality of this work. The studies sampled n = 26,764 participants (n = 12,384 girls and n = 12,905 boys, n = 1475 no information) with an average age of 8.08 years (SD = 5.26). The included reports suggest that irritability has an association with lower effortful control, lower cognitive control and delay intolerance. Further, evidence indicates both cross-sectional and longitudinal associations between irritability and a lack of regulation skills for positive and negative emotions, particularly anger. Physiological regulation seems to moderate the association between irritability and psychopathology. Finally, the mutual influence between a child's irritability and parenting practice has been established in several studies. This review uses the lens of SRC to illustrate the current understanding of irritability in psychopathology, discusses important gaps in the literature, and highlights new avenues for further research.

Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life

BACKGROUND

Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional "disturbances of self-organisation" (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms.

METHODS

This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology.

RESULTS

DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms.

CONCLUSIONS

Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.

The mediating role of flow state between recovery and energy levels: An experience sampling method study

This study uses a resource perspective that combines theories used commonly to explore recovery experiences as a theoretical framework and investigate the effects of recovery at the beginning of the workday on exhaustion and vigour at the end of the workday, with workflow in the morning as a mediator. An experience sampling method was used to collect data from 84 fulltime employees. Participants received three survey links each workday over a 2-week period, resulting in 837 days-level and 2517 data points. Hierarchical linear regression was used to test hypotheses, with results suggesting that greater recovery at the beginning of the workday correlated negatively with exhaustion and positively with vigour at the end of the workday. Recovery at the beginning correlated positively with flow state in the morning, and flow state correlated positively with vigour at the end of the workday. Flow state in the morning mediated the relationship between recovery level at the beginning and vigour at the end of the workday. These findings suggest the importance of recovery and the effects of flow state on employees' vigour.

The Short-Term Course of Nonsuicidal Self-Injury Among Individuals Seeking Psychiatric Treatment

Importance

A major portion of adolescents and adults seeking psychiatric treatment report nonsuicidal self-injury (NSSI) within the past month, yet the short-term course of NSSI among these patients remains poorly understood.

Objective

To advance the understanding of the short-term course of NSSI cognitions (ie, thoughts, urges, and self-efficacy to resist self-injury) and behavior.

Design, Setting, and Participants

A cohort study was conducted using an intensive longitudinal design with ecological momentary assessment, including 6 daily surveys and event registrations of self-injury for 28 days. Data were collected from June 2021 to August 2023. Individuals using mental health services in the Flanders region in Belgium reporting past-month NSSI urges and/or behavior at intake were recruited by referral.

Main Outcomes and Measures

Nonsuicidal self-injury thoughts, urges, self-efficacy, and behavior. Sociodemographic and clinical baseline characteristics served as between-person variables. Descriptive and variability statistics and dynamic structural equation modeling were used.

Results

Participants completed a mean (SD) of 121 (34.5) surveys, totaling 15 098 longitudinal assessments (median adherence, 78.6%; IQR, 59.5%-88.7%). Among 125 patients (87.2% female; median age, 22.0 [range, 15-39] years; 52.8% heterosexual), NSSI thoughts and urges were present during most assessments but were low in intensity (individual means [SD] on a 0- to 6-point scale, 1.52 [1.13] for urges; 1.57 [1.18] for thoughts). The prevalence of NSSI behavior was 84.0% monthly, 49.90% weekly, and 18.19% daily. Between-patient variability was substantial (intraclass correlation coefficient, 0.43-0.47; range of individual means for cognitions, 0-6; individual frequency behavior, 0-103), with recency and frequency of NSSI thoughts and behavior at intake consistently associated with individual differences in the course of NSSI. The greatest variability was observed within patients (root mean square of successive differences from 1.31 for self-efficacy to 1.40 for instability of thoughts), characterized by changes in the intensity of cognitions by more than 1 within-person SD between assessments less than 2 hours apart in 1 of 5 instances. Nonsuicidal self-injury behavior is rare in the morning, increased in the afternoon, and most frequent in the evening. Nonsuicidal self-injury cognitions were contemporaneous and temporally associated with each other's course, with higher-than-usual thoughts and lower self-efficacy uniquely signaling heightened risk for NSSI behavior in the next 2 hours.

Conclusions and Relevance

In this cohort study of treatment-seeking individuals, NSSI cognitions and behavior appeared to be dynamic over the short term. These findings suggest the potential utility of self-monitoring outside the therapy setting and the need to focus assessment and interventions on the evening hours.

Associations between daily affective experiences, trait and daily rumination on negative and positive affect: a diary study

BACKGROUND

Rumination has mostly been studied in relation to depression, however, it may also occur in response to positive emotions (i.e., positive rumination) and therefore may be a protective factor related to the maintenance of positive mood.

OBJECTIVE

We hypothesized that daily positive and negative affect would be associated with daily positive and negative rumination even after controlling for trait-level rumination.

METHOD

We carried out a diary study with university students (n = 178), where participants had to answer short surveys online about their daily affect and daily rumination every evening for 10 days. We analyzed our data with multilevel regression in R.

RESULTS

Daily positive and negative affect were significantly associated with daily negative and positive rumination, while trait-level rumination scores were not. Daily and trait-level rumination were moderately correlated (r = 0.333-0.440).

CONCLUSIONS

Our findings highlight that daily rumination plays a more significant role in daily emotional experiences than trait rumination across positive and negative valence domains. Daily negative affect appears to be more closely related to higher daily negative rumination than the lack of daily positive rumination, which could be relevant for intervention strategies.

Enabling analytical power calculations for multilevel models with autocorrelated errors through deriving and approximating the precision matrix

To unravel how within-person psychological processes fluctuate in daily life, and how these processes differ between persons, intensive longitudinal (IL) designs in which participants are repeatedly measured, have become popular. Commonly used statistical models for those designs are multilevel models with autocorrelated errors. Substantive hypotheses of interest are then typically investigated via statistical hypotheses tests for model parameters of interest. An important question in the design of such IL studies concerns the determination of the number of participants and the number of measurements per person needed to achieve sufficient statistical power for those statistical tests. Recent advances in computational methods and software have enabled the computation of statistical power using Monte Carlo simulations. However, this approach is computationally intensive and therefore quite restrictive. To ease power computations, we derive simple-to-use analytical formulas for multilevel models with AR(1) within-person errors. Analytic expressions for a model family are obtained via asymptotic approximations of all sample statistics in the precision matrix of the fixed effects. To validate this analytical approach to power computation, we compare it to the simulation-based approach via a series of Monte Carlo simulations. We find comparable performances making the analytic approach a useful tool for researchers that can drastically save them time and resources.

Examining the reciprocal associations between symptoms of depression and anxiety and contact with the criminal justice system

BACKGROUND

Taken together, prior publications on the association between symptoms of depression and anxiety and contact with the criminal justice system (CJS) suggest a bi-directional relationship, but all the studies only focus on one direction in this relationship.

AIMS

To examine, in longitudinally collected data, period-specific within-individual change in anxiety and depression measures preceding arrest measurement and, separately, following arrest measurement.

METHODS

Data were obtained from the National Longitudinal Study of Youth 1997, a nationally representative sample of people born between 1980 and 1984 and first interviewed between ages 12-17 and a publicly accessible database. Our focus was on data for the 11 years 2000-2010. Using whole sample data, we tested for a reciprocal association between depression and anxiety during each 2-year period and arrests during the following year, and vice versa, allowing for relatively fixed characteristics such as sex, age and socio-economic indicators. We used period-specific change modelling to test relationships.

RESULTS

We found that within-individual increases in depression and anxiety scores over short periods (2-year periods) of time was associated with an increase in the number of arrests subsequent over the following year, consistently throughout the whole of the 10 years studies. The reciprocal association was also observed, albeit the magnitude of the effects was much smaller.

CONCLUSION

This study adds to the literature on the association between mental health and CJS contact by showing that they may be reciprocally associated. This suggests that facilitating co-working or even formal partnerships between community mental health services and justice-related services could be beneficial.

Feasibility and Acceptability of Ecological Momentary Assessment to Assess Suicide Risk among Young People with Mood Disorder in China

Suicidal thoughts and behaviors (STBs) are increasing among young people (aged 12-24 years) in China. Although Ecological Momentary Assessment (EMA) has been increasingly used to study STBs worldwide, no study has been conducted on young people with mood disorders (MD) in China. This mixed-method study aimed to evaluate the feasibility and acceptability of suicide risk monitoring in 75 young people with MD. Participants completed five to eight daily EMA surveys and wore smart bands for the EMA study. Semi-structured interviews were used to collect feedback. High adherence to EMA surveys (73.0 %) and smart bands (87.4 %) indicated feasibility. Participants reported an overall positive experience with the EMA study (helpful, friendly, and acceptable). Additionally, the reasons they were willing to comply with the EMA study were: (1) seeing the possibility of returning to "normal," and (2) experiencing the process of returning. However, a small proportion of participants had negative experiences (e.g., annoyance and missing prompts). The results of this mixed-methods study provide preliminary support for the feasibility and acceptability of using EMA (combined smartphones and wearable sensor devices) to assess suicidality among young people with MD in the Chinese cultural and social context.

Examination of Acceptability, Feasibility, and Iatrogenic Effects of Ecological Momentary Assessment (EMA) of Suicidal Ideation

Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect.

The daily association between positive affect and psychotic experiences in individuals along the early stages of the psychosis continuum

Introduction

Psychosis often develops gradually along a continuum of severity. Little is known about the role of protective factors such as positive affect (PA) in the development of psychotic experiences (PEs). This study investigated i) the temporal (between-day) and contemporaneous (within-day) daily associations between PA and PEs in individuals at different early clinical stages for psychosis and ii) whether these associations differed per clinical stage.

Methods

Daily diary data for 90 days came from 96 individuals at risk for psychosis, distributed over four subgroups defined according to the clinical staging model (stages 0-1b). We constructed multilevel models with PA as a predictor of PEs and vice versa. We investigated within- and between-person temporal and contemporaneous associations and tested whether these associations differed among early stages with multilevel moderation analyses.

Results

We found no within-person temporal effects between PA and PEs in either direction. Contemporaneously, current-day PA predicted current-day PEs (B = -0.14, p < 0.001) and vice versa (B = -0.61, p < 0.001). Between persons, more 90-day PA predicted fewer PEs in the temporal model (B = -0.14, p = 0.03). In addition, more 90-day PEs predicted PA in the temporal (B = -0.26, p < 0.001) and contemporaneous (B = -0.36, p < 0.001) models. The contemporaneous association between PA and PEs was stronger in individuals at ultra-high risk (UHR) for psychosis than in earlier stages.

Discussion

Our study supported a significant within-day, bidirectional relationship between PA and PEs. This suggests that a focus on PA and methods to improve PA may be an important addition to early intervention practices, particularly in those at UHR for psychosis.

Emotional and interpersonal states following dialectical behavioral therapy in adolescent borderline personality disorder: A proof-of-concept ecological momentary assessment outcome study

Objective: The effects of Dialectical Behavioral Therapy for Adolescents (DBT-A) on emotional and interpersonal instability were explored in adolescents exhibiting Borderline Personality Disorder (BPD) features, using ecological momentary assessment (EMA) to reduce recall bias.Method: N = 28 help-seeking female adolescents were enrolled, meeting ≥ 3 DSM-IV BPD criteria. BPD criteria, non-suicidal self-injury (NSSI), and depressive symptoms were examined pre- and post-DBT-A treatment (mean duration: 42.74 weeks, SD = 7.46). Participants maintained e-diaries pre- and post-treatment, hourly rating momentary affect, attachment to mother and best friend, and self-injury urges.Results: Interview-rated BPD symptoms decreased (χ²(1) = 5.66, p = .017), alongside reduced self-rated depression severity (χ²(1) = 9.61, p = .002). EMA data showed decreased NSSI urges (χ²(1) = 9.05, p = .003) and increased mother attachment (χ²(1) = 6.03, p = .014). However, mean affect, affective instability, mean attachment to the best friend, and attachment instability showed no significant change over time.Conclusion: DBT-A yielded limited evidence for altering momentary affective states and instability in adolescents based on EMA. Nevertheless, significant effects were observed in reducing NSSI urges and enhancing interpersonal dynamics during treatment, as assessed via EMA.

Abnormalities in emotion regulation are associated with negative, but not positive or disorganized schizotypy: An experience sampling study

BACKGROUND

Schizotypy, a multidimensional construct with positive, negative, and disorganized dimensions, represents a vulnerability marker for the development of schizophrenia. Although there has been increasing evidence linking schizotypy to emotion regulation (ER) deficits, the specific association between different schizotypal dimensions and alterations in ER strategy use in daily life remains poorly understood.

METHODS

Using the experience sampling method (ESM), the present study examined the associations between positive, negative, and disorganized schizotypy and ER strategy use in daily life in a nonclinical young adult sample (N = 258). Participants were instructed to report their ER strategy use 5 times a day for 14 days. Four adaptive ER strategies (reflection, reappraisal, social sharing, and distraction) and two maladaptive ER strategies (suppression and rumination) were included.

RESULTS

Multilevel modeling analyses showed that positive schizotypal traits predicted greater use of adaptive ER strategies, while negative schizotypal traits predicted less use of adaptive ER strategies and more frequent use of emotional suppression in daily life. No associations between disorganized schizotypal traits and any ER strategy use were found.

CONCLUSION

Schizotypy dimensions are differentiated by preferences for different ER strategies in daily life. The findings suggest a strong association between negative schizotypy and notable dysfunctions in ER, emphasizing the significance of negative schizotypy as a vulnerability factor for psychosis.

The experience sampling methodology as a digital clinical tool for more person-centered mental health care: an implementation research agenda

This position paper by the international IMMERSE consortium reviews the evidence of a digital mental health solution based on Experience Sampling Methodology (ESM) for advancing person-centered mental health care and outlines a research agenda for implementing innovative digital mental health tools into routine clinical practice. ESM is a structured diary technique recording real-time self-report data about the current mental state using a mobile application. We will review how ESM may contribute to (1) service user engagement and empowerment, (2) self-management and recovery, (3) goal direction in clinical assessment and management of care, and (4) shared decision-making. However, despite the evidence demonstrating the value of ESM-based approaches in enhancing person-centered mental health care, it is hardly integrated into clinical practice. Therefore, we propose a global research agenda for implementing ESM in routine mental health care addressing six key challenges: (1) the motivation and ability of service users to adhere to the ESM monitoring, reporting and feedback, (2) the motivation and competence of clinicians in routine healthcare delivery settings to integrate ESM in the workflow, (3) the technical requirements and (4) governance requirements for integrating these data in the clinical workflow, (5) the financial and competence related resources related to IT-infrastructure and clinician time, and (6) implementation studies that build the evidence-base. While focused on ESM, the research agenda holds broader implications for implementing digital innovations in mental health. This paper calls for a shift in focus from developing new digital interventions to overcoming implementation barriers, essential for achieving a true transformation toward person-centered care in mental health.

Catalysts of digital excellence: Unraveling the threads of connectivity, embedment, and visibility in enterprise social media for enhanced task and innovative performances

In an era characterized by rapid digital transformation, this research delves into the intricate dynamics of enterprise social media (ESM) ubiquitous connectivity, drawing on the influential framework of social cognitive theory (SCT), we unravel the complex relationships among compatibility, presenteeism, ESM-enabled embeddedness, and the visibility of digital interactions, shedding light on how these factors collectively shape task performance and innovative contributions in the contemporary hybrid work landscape. By incorporating SCT into our research model, we not only enhance the theoretical underpinning but also respond to the imperative of understanding how individual cognition and observational learning impact behaviors in digital work environments. Data is collected from 467 participants from China. Results indicated that ESM-enabled embeddedness mediates the connection between presenteeism and both digital-enabled task performance, digital-enabled innovative performance. Findings conformed that ESM-enabled embeddedness mediates the connection between compatibility and both digital-enabled task performance, digital-enabled innovative performance. ESM visibility strengthens the connection between ubiquitous connectivity (presenteeism, compatibility) and ESM-enabled embeddedness. In addition, results also indicated that ESM visibility moderates the mediation effect of ESM-enabled embeddedness between the dimensions of ESM ubiquitous connectivity (presenteeism) and both digital-enabled task performance, digital-enabled innovative performance. In contrast, ESM visibility did not moderates the mediation effect of ESM-enabled embeddedness between the dimensions of ESM ubiquitous connectivity (compatibility) and both digital-enabled task performance, digital-enabled innovative performance. This study not only contributes depth to ESM literature but also lays the groundwork for future research endeavors, encouraging exploration of diverse contexts and additional moderating factors to comprehensively grasp the intricate dynamics within modern digital workspaces.

The Role of Childhood Trauma in Affective Stress Recovery in Early Psychosis: An Experience Sampling Study

BACKGROUND AND HYPOTHESES

Affective recovery, operationalized as the time needed for affect to return to baseline levels after daily stressors, may be a putative momentary representation of resilience. This study aimed to investigate affective recovery in positive and negative affect across subclinical and clinical stages of psychosis and whether this is associated with exposure to childhood trauma (sexual, physical, and emotional abuse).

STUDY DESIGN

We used survival analysis to predict the time-to-recovery from a daily event-related stressor in a pooled sample of 3 previously conducted experience sampling studies including 113 individuals with first-episode psychosis, 162 at-risk individuals, and 94 controls.

STUDY RESULTS

Negative affective recovery (ie, return to baseline following an increase in negative affect) was longer in individuals with first-episode psychosis compared with controls (hazard ratio [HR] = 1.71, 95% confidence interval [CI; 1.03, 2.61], P = .04) and in at-risk individuals exposed to high vs low levels of emotional abuse (HR = 1.31, 95% CI [1.06, 1.62], P = .01). Positive affective recovery (ie, return to baseline following a decrease in positive affect) did not differ between groups and was not associated with childhood trauma.

CONCLUSIONS

Our results give first indications that negative affective recovery may be a putative momentary representation of resilience across stages of psychosis and may be amplified in at-risk individuals with prior experiences of emotional abuse. Understanding how affective recovery contributes to the development of psychosis may help identify new targets for prevention and intervention to buffer risk or foster resilience in daily life.

Does daily nature exposure enhance children's self-worth and positive feelings? An experience sampling study

Previous studies suggest that nature exposure has positive effects on children's cognitive performance and well-being . However, inconsistent evidence was found for effects on children's self-worth and feelings. These inconsistencies may be resolved by studying children's actual exposure and experiences in detail. Therefore, in the present study, we investigated the effect of daily nature exposure on children's self-worth and feelings with an experience sampling method. Sixty-six third graders (29 girls, mean age = 9.04 years) participated two to three times per day consecutively for 9 days. The resulting 1199 observations were analyzed and showed that when exposed to nature children reported significantly higher self-worth and positive feelings than when not exposed to nature, with baseline levels controlled. Positive feelings played mediating roles in relationships between nature exposure and children's self-worth. Our study strengthens the evidence on beneficial effects of nature on children's well-being. The mechanisms involved in this effect are discussed.

Closing the loop between environment, brain and mental health: how far we might go in real-life assessments?

PURPOSE OF REVIEW

Environmental factors such as climate, urbanicity, and exposure to nature are becoming increasingly important influencers of mental health. Incorporating data gathered from real-life contexts holds promise to substantially enhance laboratory experiments by providing a more comprehensive understanding of everyday behaviors in natural environments. We provide an up-to-date review of current technological and methodological developments in mental health assessments, neuroimaging and environmental sensing.

RECENT FINDINGS

Mental health research progressed in recent years towards integrating tools, such as smartphone based mental health assessments or mobile neuroimaging, allowing just-in-time daily assessments. Moreover, they are increasingly enriched by dynamic measurements of the environment, which are already being integrated with mental health assessments. To ensure ecological validity and accuracy it is crucial to capture environmental data with a high spatio-temporal granularity. Simultaneously, as a supplement to experimentally controlled conditions, there is a need for a better understanding of cognition in daily life, particularly regarding our brain's responses in natural settings.

SUMMARY

The presented overview on the developments and feasibility of "real-life" approaches for mental health and brain research and their potential to identify relationships along the mental health-environment-brain axis informs strategies for real-life individual and dynamic assessments.

Cognitive emotion regulation difficulties increase affective reactivity to daily-life stress in autistic adolescents and young adults

LAY ABSTRACT

Previous research has shown that autistic individuals report high levels of perceived stress and have an increased likelihood of developing mental health difficulties. Increase in individuals' negative emotions in relation to perceived stress (i.e. affective reactivity to stress) is a known risk factor for mental health difficulties. In this study, we investigated perceived daily stress and affective reactivity to stress in autistic (n = 39, age = 18.4) and non-autistic (n = 55, age = 18.1) adolescents and young adults. We used the ecological momentary assessment, a technique that allows to assess individuals repeatedly in their daily life using their smartphone. Moreover, participants filled a questionnaire to evaluate the strategies they use to regulate emotions when faced with difficulties. Finally, a clinical interview and a parent-report questionnaire were used to assess mental health symptoms. Autistic youth reported higher levels of perceived daily stress compared with non-autistic peers. Moreover, they showed increased affective reactivity to stress related to their daily activities. Autistic participants reported more emotion regulation difficulties (e.g. more repetitive thinking of difficulties) compared with non-autistic participants. Difficulties in emotion regulation increased negative emotions in relation to stress and might contribute to the severity of mental health symptoms. We conclude that adolescents and young adults with autism report high perceived stress in their daily lives. To minimize the negative impact of stress and the development of mental health symptoms, people supporting autistic young people could focus on stress management skills and the strategies that the youth use to manage emotions.

A Daily Diary Study of the Relation between Stress and Nonsuicidal Self-Injury and the Moderating Role of Emotion Dysregulation in Emerging Adulthood

Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable.