Implementierung, Akzeptanz und Informationsgehalt eines Ecological Momentary Assessment (EMA)-Ansatzes bei Patienten mit Panikstörung und Agoraphobie

Measurement reactivity in ambulatory assessment: Increase in emotional clarity over time independent of sampling frequency

Ambulatory assessment (AA) studies are frequently used to study emotions, cognitions, and behavior in daily life. But does the measurement itself produce reactivity, that is, are the constructs that are measured influenced by participation? We investigated individual differences in intraindividual change in momentary emotional clarity and momentary pleasant-unpleasant mood over the course of an AA study. Specifically, we experimentally manipulated sampling frequency and hypothesized that the intraindividual change over time would be stronger when sampling frequency was high (vs. low). Moreover, we assumed that individual differences in dispositional mood regulation would moderate the direction of intraindividual change in momentary pleasant-unpleasant mood over time. Students (n = 313) were prompted either three or nine times a day for 1 week (data collection took place in 2019 and 2020). Multilevel growth curve models showed that momentary emotional clarity increased within participants over the course of the AA phase, but this increase did not differ between the two sampling frequency groups. Pleasant-unpleasant mood did not show a systematic trend over the course of the study, and mood regulation did not predict individual differences in mood change over time. Again, results were not moderated by the sampling frequency group. We discuss limitations of our study (e.g., WEIRD sample) and potential practical implications regarding sampling frequency in AA studies. Future studies should further systematically investigate the circumstances under which measurement reactivity is more likely to occur.

The relationship between momentary experiential avoidance and anxiety symptoms

BACKGROUND

Experiential avoidance (EA) may serve as a risk factor for a wide range of anxiety-related psychopathology. Anxiety is thought to trigger the use of EA, while also serving as a consequence of EA efforts. Previous ecological momentary assessment (EMA) studies found that EA was associated with greater anxiety in nonclinical undergraduates and patients with social anxiety disorder.

METHODS

The present study examined the in-the-moment, bidirectional relationship between EA, perceived stress, and two facets of anxiety (autonomic arousal and worry/misery) in a sample of treatment-seeking patients broadly diagnosed with an anxiety-related disorder (N = 46). Participants completed a baseline assessment followed by an EMA assessment period (assessments three times daily for seven days). We hypothesized that there would be a bidirectional relationship between EA and anxiety/stress.

RESULTS

Results largely supported a unidirectional relationship such that greater EA at one time point predicted higher stress at a later time point controlling for previous stress levels and linear time. Trend-level associations between EA and anxiety symptoms are discussed.

CONCLUSIONS

The current study provides important insight into the relationship between EA and anxiety symptoms in a clinical sample of participants with anxiety-related disorders.

Evaluating a Hybrid Web-Based Training Program for Panic Disorder and Agoraphobia: Randomized Controlled Trial

BACKGROUND

Previous studies provide evidence for the effectiveness of web-based interventions for panic disorder with and without agoraphobia. Smartphone-based technologies hold significant potential for further enhancing the accessibility and efficacy of such interventions.

OBJECTIVE

This randomized controlled trial aims to evaluate the efficacy of a guided, hybrid web-based training program based on cognitive behavioral therapy for adults with symptoms of panic disorder.

METHODS

Participants (N=92) with total scores in the Panic and Agoraphobia Scale ranging from 9 to 28 were recruited from the general population and allocated either to a hybrid intervention (GET.ON Panic) or to a wait-list control group. The primary outcome was the reduction in panic symptoms, as self-assessed using a web-based version of the Panic and Agoraphobia Scale.

RESULTS

Analysis of covariance-based intention-to-treat analyses revealed a significantly stronger decrease in panic symptoms posttreatment (F=9.77; P=.002; Cohen d=0.66; 95% CI 0.24-1.08) in the intervention group than in the wait-list control group. Comparisons between groups of the follow-up measures at 3 and 6 months yielded even stronger effects (3-month follow-up: F=17.40, P<.001, Cohen d=0.89, 95% CI 0.46-1.31; 6-month follow-up: F=14.63, P<.001, Cohen d=0.81, 95% CI 0.38-1.24).

CONCLUSIONS

Hybrid web-based training programs may help reduce the symptoms of panic disorder and hence play an important role in improving health care for patients with this debilitating disorder.

TRIAL REGISTRATION

German Clinical Trial Register DRKS00005223; https://tinyurl.com/f4zt5ran.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/1745-6215-15-427.

Experience sampling and ecological momentary assessment for studying the daily lives of patients with anxiety disorders: a systematic review

Anxiety disorders are highly prevalent. Symptoms may occur unpredictably (e.g., panic attacks) or predictably in specific situations (e.g., social phobia). Consequently, it may be difficult to assess anxiety and related constructs realistically in the laboratory or by traditional retrospective questionnaires. Experience sampling methods (ESM) and ecological momentary assessment (EMA) can deepen the understanding of the course of anxiety disorders by frequently assessing symptoms and other variables in the natural environment. We review 34 ESM/EMA studies on adult panic disorder, generalized anxiety disorder, social phobia, post-traumatic stress disorder, and obsessive-compulsive disorder, as well as anxiety disorders in youth. Benefits of ESM/EMA for the study of anxiety disorders include generating insight into the temporal variability of symptoms and into the associations among daily affect, behaviors, and situational cues. Further, ESM/EMA has been successfully combined with ambulatory assessment of physiological variables and with treatment evaluations. We provide suggestions for future research, as well as for clinical applications.

Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial

Background

Recently, internet-based interventions have been proposed as effective treatments for people with panic disorder (PD). However, little is known about the clinical effects of integrating mobile technology into these interventions. Because users carry their smartphones with them throughout the day, we hypothesize that this technology can be used to significantly support individuals with monitoring and overcoming their PD symptoms. The aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed hybrid intervention that combines internet/PC with smartphone delivery to treat the symptoms of PD. The intervention is based on cognitive behavioral therapy and consists of six modules over a total of six weeks.

Methods/Design

A two-arm randomized controlled trial (RCT) will be conducted to evaluate the effects of a hybrid online training module for PD. Based on a power calculation (d =0.60; 1-β of 80%; α =0.05), 90 participants with mild to moderate panic symptoms with or without agoraphobia (as assessed by the Panic and Agoraphobia Scale) will be recruited from the general population and randomly assigned to either the intervention group or a six-month waitlist control group. The primary outcome measure will be the severity of panic symptoms. Secondary outcomes will include depression, quality of life, and an observer-based rating of panic severity. Furthermore, data regarding acceptance and the usability of the smartphone app will be assessed. Assessments will take place at baseline as well as eight weeks, three months, and six months after randomization. Moreover, a cost-effectiveness analysis will be performed from a societal perspective. Data will be analyzed on an intention-to-treat basis and per protocol.

Discussion

To our knowledge, this RCT is one of the first to examine the efficacy of a hybrid online training for adult PD. This study seeks to contribute to the emerging field of hybrid online training. If the intervention is efficacious, then research on this hybrid online training should be extended. The cost-effectiveness analysis will also indicate whether online training is an economical tool for treating PD among adults.

Trial registration

German Clinical Trial Register: DRKS00005223 (registered on 15 August 2013).

Psychometrische Eigenschaften des Fragebogens zur Errötungsangst (FEA)

Der Fragebogen zur Errötungsangst (FEA) erfasst subjektiv wahrgenommenes Erröten und die Angst davor auf sieben nach klinischen Gesichtspunkten definierten Subskalen. Die psychometrischen Gütekriterienbestimmung erfolgte in drei Stichproben: 260 Studenten, 62 Errötungsängstliche und 71 Patienten mit Sozialer Angststörung mit Errötungsangst. Zur Konstruktvalidierung wurden die Variablen Soziale Ängstlichkeit, psychopathologische Symptombelastung, Selbstwert und Persönlichkeitsfaktoren erfasst. Die Subskalen wiesen überwiegend niedrige Skaleninterkorrelationen auf. Die interne Konsistenz war mit Ausnahme zweier Skalen zufrieden stellend (Cronbachs α ≥ .74), die Retest-Reliabilität mit einer Ausnahme gut (rtt ≥ .77). Die Konstruktvalidität variierte abhängig von den betrachteten Subskalen. Veränderungen durch Psychotherapie wurden sensitiv abgebildet. Studentische und klinische Stichproben konnten mittels Diskriminanzanalyse zu 90 % korrekt zugeordnet werden. Mittels ROC-Analyse wurde für die Subskala Errötungsangst ein Schwellenwert von 3.6 ermittelt. Angesichts guter psychometrischer Eigenschaften der Subskala Errötungsangst und gleichzeitiger Einschränkungen bei der Validierung einiger Teilskalen, wird je nach Verwendungszweck der Einsatz des FEA als Kurz- oder Langform vorgeschlagen.

Anticipatory Anxiety as a Function of Panic Attacks and Panic-Related Self-Efficacy: An Ambulatory Assessment Study in Panic Disorder

Background: Panic attacks and anticipatory anxiety are considered to be inter-correlated, yet distinctive, features of panic disorder, both contributing to its onset and maintenance as well as to the associated impairment. Given the difficulty to yield ecologically valid data on these fluctuating symptoms the natural course of anticipatory anxiety and its correlates have seldom been addressed with adequate methods. Aims: The current study aimed at further exploring the natural variance of anticipatory anxiety and its interdependence with panic-related variables. In addition, impact of anxiety sensitivity, and perceived ability to cope with panic on the relation between panic attacks and subsequent anxiety was inspected. Method: Based on an Ecological Momentary Assessment approach, 21 patients with panic disorder rated study variables continuously over one week; 549 question sets were completed. Results: Anticipatory anxiety followed a diurnal pattern and was associated with situational and internal variables typically linked to panic experiences. Preceding panic attacks intensified anticipatory anxiety and associated negative emotional states; however, perceived ability to cope attenuated these effects. Conclusion: Based on natural observation data, results largely support the importance of cognitive appraisals for anticipatory anxiety, and its interplay with panic attacks as it has been suggested by cognitive theory and recent findings in extinction learning research.