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Postma MR, Vrancken S, Daemen M, Meulen IHVD, Volbragt N, Delespaul P, Haan LD, Pluijm MVD, Breedvelt JJF, Gaag MVD, Lindauer R, Berg DVD, Bockting C, Amelsvoort TV, Schwannauer M, Doi L, Reininghaus U. Working mechanisms of the use and acceptability of ecological momentary interventions: a realist evaluation of a guided self-help ecological momentary intervention targeting self-esteem. BMC Public Health 2024; 24:1633. [PMID: 38898412 PMCID: PMC11186172 DOI: 10.1186/s12889-024-19143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Technology improves accessibility of psychological interventions for youth. An ecological momentary intervention (EMI) is a digital intervention geared toward intervening in daily life to enhance the generalizability and ecological validity, and to be able to intervene in moments most needed. Identifying working mechanisms of the use of ecological momentary interventions might generate insights to improve interventions. METHODS The present study investigates the working mechanisms of the use and acceptability of an ecological momentary intervention, named SELFIE, targeting self-esteem in youth exposed to childhood trauma, and evaluates under what circumstances these mechanisms of use and acceptability do or do not come into play. A realist evaluation approach was used for developing initial program theories (data: expert interviews and a stakeholders focus group), and subsequently testing (data: 15 interviews with participants, a focus group with therapists, debriefing questionnaire), and refining them. RESULTS The SELFIE intervention is offered through a smartphone application enabling constant availability of the intervention and thereby increasing accessibility and feasibility. When the intervention was offered on their personal smartphone, this enhanced a sense of privacy and less hesitance in engaging with the app, leading to increased disclosure and active participation. Further, the smartphone application facilitates the practice of skills in daily life, supporting the repeated practice of exercises in different situations leading to the generalizability of the effect. Buffering against technical malfunction seemed important to decrease its possible negative effects. CONCLUSIONS This study enhanced our understanding of possible working mechanisms in EMIs, such as the constant availability supporting increased accessibility and feasibility, for which the use of the personal smartphone was experienced as a facilitating context. Hereby, the current study contributes to relatively limited research in this field. For the field to move forward, mechanisms of use, and acceptability of EMIs need to be understood. It is strongly recommended that alongside efficacy trials of an EMI on specific target mechanisms, a process evaluation is conducted investigating the working mechanisms of use. TRIAL REGISTRATION The current paper reports on a realist evaluation within the SELFIE trial (Netherlands Trial Register NL7129 (NTR7475)).
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Affiliation(s)
- Mary Rose Postma
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands.
- Mondriaan Mental Health Center, Heerlen, The Netherlands.
| | | | - Maud Daemen
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands
| | | | - Nele Volbragt
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands
- Mondriaan Mental Health Center, Heerlen, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
| | - Marieke van der Pluijm
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
| | - Josefien Johanna Froukje Breedvelt
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Ramon Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
- Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
- Parnassia Academy, The Hague, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands
- Mondriaan Mental Health Center, Heerlen, The Netherlands
| | | | - Lawrence Doi
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Ulrich Reininghaus
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, UK
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Shuai R, Ahmed-Leitao F, Bloom J, Seedat S, Hogarth L. Brief online negative affect focused functional imagery training (FIT) improves four-week drinking outcomes in hazardous student drinkers: A pilot randomised controlled trial replication in South Africa. Addict Behav Rep 2024; 19:100540. [PMID: 38586438 PMCID: PMC10995806 DOI: 10.1016/j.abrep.2024.100540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Background Previous study has shown that functional imagery training (FIT) to utilise positive mental imagery in response to negative affect could improve alcohol-related outcomes. The current study aimed to replicate whether this negative affect focused FIT would improve alcohol-related outcomes in hazardous student drinkers in South Africa at four-week follow-up. Methods 50 hazardous student drinkers who reported drinking to cope with negative affect were randomised into two groups. The active group (n = 25) was trained online over two weeks to respond to personalised negative drinking triggers by retrieving a personalised adaptive strategy they might use to mitigate negative affect, whereas the control group (n = 25) received standard risk information about binge drinking. Outcome measures including alcohol consumption, drinking motives, anxiety and depression, self-efficacy and use of protective behavioural strategies were obtained at baseline and four-week follow-up. Results FIT effects were revealed by three significant group-by-timepoint interactions in a per-protocol analysis: there was a significant decrease in depressive symptoms, drinking to cope and drinking for social reasons from baseline to follow-up in the active group, but not the control group. No effects were observed on alcohol consumption, self-efficacy, protective behaviour strategies and anxiety. Conclusions Preliminary evidence supports that online negative affect focused FIT can improve depression as well as coping and social drinking motives in South African hazardous student drinkers who drank to cope, at four-week follow-up, suggesting that the principles of this FIT approach might be adapted and incorporated into a clinical intervention to test for efficacy in mitigating substance use problems.
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Affiliation(s)
- Ruichong Shuai
- School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Fatima Ahmed-Leitao
- Department of Psychiatry, Stellenbosch University, Private Bag X1, Matieland, 7602, Stellenbosch, South Africa
| | - Jenny Bloom
- Department of Psychiatry, Stellenbosch University, Private Bag X1, Matieland, 7602, Stellenbosch, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Private Bag X1, Matieland, 7602, Stellenbosch, South Africa
| | - Lee Hogarth
- School of Psychology, University of Exeter, Exeter, United Kingdom
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Bakhireva LN, Solomon E, Roberts MH, Ma X, Rai R, Wiesel A, Jacobson SW, Weinberg J, Milligan ED. Independent and Combined Effects of Prenatal Alcohol Exposure and Prenatal Stress on Fetal HPA Axis Development. Int J Mol Sci 2024; 25:2690. [PMID: 38473937 PMCID: PMC10932119 DOI: 10.3390/ijms25052690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Prenatal alcohol exposure (PAE) and prenatal stress (PS) are highly prevalent conditions known to affect fetal programming of the hypothalamic-pituitary-adrenal (HPA) axis. The objectives of this study were to assess the effect of light PAE, PS, and PAE-PS interaction on fetal HPA axis activity assessed via placental and umbilical cord blood biomarkers. Participants of the ENRICH-2 cohort were recruited during the second trimester and classified into the PAE and unexposed control groups. PS was assessed by the Perceived Stress Scale. Placental tissue was collected promptly after delivery; gene and protein analysis for 11β-HSD1, 11β-HSD2, and pCRH were conducted by qPCR and ELISA, respectively. Umbilical cord blood was analyzed for cortisone and cortisol. Pearson correlation and multivariable linear regression examined the association of PAE and PS with HPA axis biomarkers. Mean alcohol consumption in the PAE group was ~2 drinks/week. Higher PS was observed in the PAE group (p < 0.01). In multivariable modeling, PS was associated with pCRH gene expression (β = 0.006, p < 0.01), while PAE was associated with 11β-HSD2 protein expression (β = 0.56, p < 0.01). A significant alcohol-by-stress interaction was observed with respect to 11β-HSD2 protein expression (p < 0.01). Results indicate that PAE and PS may independently and in combination affect fetal programming of the HPA axis.
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Affiliation(s)
- Ludmila N. Bakhireva
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (M.H.R.); (X.M.); (R.R.); (A.W.)
| | - Elizabeth Solomon
- Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (E.S.); (E.D.M.)
| | - Melissa H. Roberts
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (M.H.R.); (X.M.); (R.R.); (A.W.)
| | - Xingya Ma
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (M.H.R.); (X.M.); (R.R.); (A.W.)
| | - Rajani Rai
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (M.H.R.); (X.M.); (R.R.); (A.W.)
| | - Alexandria Wiesel
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (M.H.R.); (X.M.); (R.R.); (A.W.)
| | - Sandra W. Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Joanne Weinberg
- Department of Cellular and Physiological Sciences, Faculty of Medicine, Life Sciences Institute, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Erin D. Milligan
- Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (E.S.); (E.D.M.)
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Braun TD, Green Z, Meshesha LZ, Sillice MA, Read J, Abrantes AM. Self-compassion buffers the internalized alcohol stigma and depression link in women sexual assault survivors who drink to cope. Addict Behav 2023; 138:107562. [PMID: 36463606 PMCID: PMC10184311 DOI: 10.1016/j.addbeh.2022.107562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression is strongly implicated in drinking to cope and the development of alcohol use disorders (AUD) in women, particularly among women with a history of sexual assault victimization (SAV). Alcohol use in women is heavily stigmatized, and substance use stigma is associated with depression. This study examined the link between internalized alcohol stigma (AS) and depression and tested whether self-compassion buffered (i.e., moderated) this association in a sample of women with a history of SAV and unhealthy drinking to cope. METHOD Women sexual assault survivors (N = 288; 82 % White, 91.2 % Non-Hispanic, 20.2 % sexual minority) reporting unhealthy drinking (Alcohol Use Disorders Inventory Test-C ≥ 4) and drinking to cope (Drinking Coping Motives Questionnaire-Revised ≥ 2) completed online self-report surveys. Hierarchical regression analyses tested associations between internalized-AS and self-compassion with depression after controlling for covariates (age, income, education, AUD symptoms, and posttraumatic stress disorder) and then, whether self-compassion moderated the Internalized-AS and depression link. RESULTS Internalized-AS accounted for 1.4 % of variance in depression (p < .01); self-compassion accounted for added variance when subsequently modeled (8.2 %, p < .001). Moderation analyses revealed self-compassion to buffer the internalized-AS and depression link. Among participants reporting high levels of self-compassion, there was no association between internalized-AS and depression (p = .894). DISCUSSION While findings are modest, they align with the previously observed link between internalized-AS and depression and extend these findings to women with a history of SAV endorsing elevated coping motives and unhealthy drinking. Self-compassion may protect against this link, pending further research sampling greater diversity of participants and longitudinal and controlled designs.
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Affiliation(s)
- Tosca D Braun
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.
| | - Zoë Green
- University of Connecticut Health Center, Farmington, CT, United States
| | - Lidia Z Meshesha
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | - Marie A Sillice
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Jennifer Read
- Department of Psychology, University at Buffalo, Buffalo, NY, United States
| | - Ana M Abrantes
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States
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Dauber S, Beacham A, West A, Devkota J, Barrie K, Thrul J. Ecological Momentary Assessment of Heavy Episodic Drinking in the Early Postpartum Period: A Feasibility Study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100146. [PMID: 37012980 PMCID: PMC10066518 DOI: 10.1016/j.dadr.2023.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
Background Postpartum mothers are at heightened risk for heavy episodic drinking (HED). Research with this population is critical to developing acceptable and effective tailored interventions, but new mothers who use alcohol are often reluctant to engage in research due to stigma and fear of child removal. This study examined feasibility of recruitment and ecological momentary assessment (EMA) in early postpartum mothers with histories of HED. Methods Participants were recruited via Facebook and Reddit and completed 14 days of EMA surveys. Baseline characteristics, recruitment feasibility, and EMA feasibility and acceptability were examined. Participants attended focus groups to further inform quantitative data. Results Reddit yielded a larger proportion of eligible individuals than Facebook, and 86% of the final enroled sample was recruited via Reddit. The average compliance rate of 75% is in line with other studies of similar populations. Half the sample reported alcohol use, and 78% reported the urge to drink at least once, supporting feasibility of EMA for collecting alcohol use data. Participants reported low burden and high acceptability of the study on both quantitative and qualitative measures. Baseline low maternal self-efficacy was associated with greater EMA compliance, and first-time mothers reported lower EMA burden compared to veteran mothers. College graduates, and participants with lower drinking refusal self-efficacy and greater alcohol severity were more likely to report alcohol use on EMA. Conclusions Future studies should consider Reddit as a recruitment strategy. Findings generally support feasibility and acceptability of EMA to assess HED in postpartum mothers.
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Affiliation(s)
- Sarah Dauber
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, USA
- Corresponding author.
| | - Alexa Beacham
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, USA
| | - Allison West
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janardan Devkota
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kadjatu Barrie
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, USA
| | - Johannes Thrul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Stevenson BL, Kummerfeld E, Merrill JE, Blevins C, Abrantes AM, Kushner MG, Lim KO. Quantifying heterogeneity in mood-alcohol relationships with idiographic causal models. Alcohol Res 2022; 46:1913-1924. [PMID: 36059269 PMCID: PMC9826275 DOI: 10.1111/acer.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) studies have provided conflicting evidence for the mood regulation tenet that people drink in response to positive and negative moods. The current study examined mood-to-alcohol relationships idiographically to quantify the prevalence and intensity of relationships between positive and negative moods and drinking across individuals. METHOD We used two EMA samples: 96 heavy drinking college students (sample 1) and 19 young adults completing an ecological momentary intervention (EMI) for drinking to cope (sample 2). Mood and alcohol use were measured multiple times per day for 4-6 weeks. Mood-alcohol relationships were examined using three different analytic approaches: standard multilevel modeling, group causal modeling, and idiographic causal modeling. RESULTS Both multilevel modeling and group causal modeling showed that participants in both samples drank in response to positive moods only. However, idiographic causal analyses revealed that only 63% and 21% of subjects (in samples 1 and 2, respectively) drank following any positive mood. Many subjects (24% and 58%) did not drink in response to either positive or negative mood in their daily lives, and very few (5% and 16%) drank in response to negative moods throughout the EMA protocol, despite sample 2 being selected specifically because they endorse drinking to cope with negative mood. CONCLUSION Traditional group-level analyses and corresponding population-wide theories assume relative homogeneity within populations in mood-alcohol relationships, but this nomothetic approach failed to characterize accurately the relationship between mood and alcohol use in approximately half of the subjects in two samples that were demographically and clinically homogeneous. Given inconsistent findings in the mood-alcohol relationships to date, we conclude that idiographic causal analyses can provide a foundation for more accurate theories of mood and alcohol use. In addition, idiographic causal models may also help improve psychosocial treatments through direct use in clinical settings.
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Affiliation(s)
- Brittany L. Stevenson
- Minneapolis Veterans AffairsMinneapolisMinnesotaUSA,Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Erich Kummerfeld
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | | | - Ana M. Abrantes
- Department of Psychiatry and Human BehaviorBrown UniversityProvidenceRhode IslandUSA,Butler HospitalProvidenceRhode IslandUSA
| | - Matt G. Kushner
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Kelvin O. Lim
- Minneapolis Veterans AffairsMinneapolisMinnesotaUSA,Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
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Dauber S, Beacham A, Hammond C, West A, Thrul J. Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study (Preprint). JMIR Res Protoc 2022; 11:e36849. [PMID: 35373778 PMCID: PMC9016512 DOI: 10.2196/36849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking. Objective The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI. Methods This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described. Results Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. Conclusions The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial. International Registered Report Identifier (IRRID) PRR1-10.2196/36849
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Affiliation(s)
- Sarah Dauber
- Partnership to End Addiction, New York, NY, United States
| | - Alexa Beacham
- Partnership to End Addiction, New York, NY, United States
| | - Cori Hammond
- Partnership to End Addiction, New York, NY, United States
| | - Allison West
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Johannes Thrul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Coifman KG, Aurora P. From Social Avoidance to Substance Use: Working Memory and Negative Affectivity Predict Maladaptive Regulatory Behaviors in Daily Life Across Diagnostic Groups. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-021-10284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ecological momentary interventions for mental health: A scoping review. PLoS One 2021; 16:e0248152. [PMID: 33705457 PMCID: PMC7951936 DOI: 10.1371/journal.pone.0248152] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The development of mobile computing technology has enabled the delivery of psychological interventions while people go about their everyday lives. The original visions of the potential of these "ecological momentary interventions" were presented over a decade ago, and the widespread adoption of smartphones in the intervening years has led to a variety of research studies exploring the feasibility of these aspirations. However, there is a dearth of research describing the different dimensions, characteristics, and features of these interventions, as constructed. OBJECTIVE To provide an overview of the definitions given for "ecological momentary interventions" in the treatment of common mental health disorders, and describe the set of technological and interaction possibilities which have been used in the design of these interventions. METHODS A systematic search identified relevant literature published between 2009 and 2020 in the PubMed, PsycInfo, and ACM Guide to the Computing Literature databases. Following screening, data were extracted from eligible articles using a standardized extraction worksheet. Selected articles were then thematically categorized. RESULTS The search identified 583 articles of which 64 met the inclusion criteria. The interventions target a range of mental health problems, with diverse aims, intervention designs and evaluation approaches. The studies employed a variety of features for intervention delivery, but recent research is overwhelmingly comprised of studies based on smartphone apps (30 of 42 papers that described an intervention). Twenty two studies employed sensors for the collection of data in order to provide just-in-time support or predict psychological states. CONCLUSIONS With the shift towards smartphone apps, the vision for EMIs has begun to be realised. Recent years have seen increased exploration of the use of sensors and machine learning, but the role of humans in the delivery of EMI is also varied. The variety of capabilities exhibited by EMIs motivates development of a more precise vocabulary for capturing both automatic and human tailoring of these interventions.
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Cummins KM, Brumback T, Chung T, Moore RC, Henthorn T, Eberson S, Lopez A, Sarkissyan T, Nooner KB, Brown SA, Tapert SF. Acceptability, Validity, and Engagement With a Mobile App for Frequent, Continuous Multiyear Assessment of Youth Health Behaviors (mNCANDA): Mixed Methods Study. JMIR Mhealth Uhealth 2021; 9:e24472. [PMID: 33565988 PMCID: PMC7904399 DOI: 10.2196/24472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/10/2020] [Accepted: 12/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Longitudinal studies of many health behaviors often rely on infrequent self-report assessments. The measurement of psychoactive substance use among youth is expected to improve with more frequent mobile assessments, which can reduce recall bias. Researchers have used mobile devices for longitudinal research, but studies that last years and assess youth continuously at a fine-grained, temporal level (eg, weekly) are rare. A tailored mobile app (mNCANDA [mobile National Consortium on Alcohol and Neurodevelopment in Adolescence]) and a brief assessment protocol were designed specifically to provide a feasible platform to elicit responses to health behavior assessments in longitudinal studies, including NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence). OBJECTIVE This study aimed to determine whether an acceptable mobile app system could provide repeatable and valid assessment of youth's health behaviors in different developmental stages over extended follow-up. METHODS Participants were recruited (n=534; aged 17-28 years) from a larger longitudinal study of neurodevelopment. Participants used mNCANDA to register reports of their behaviors for up to 18 months. Response rates as a function of time measured using mNCANDA and participant age were modeled using generalized estimating equations to evaluate response rate stability and age effects. Substance use reports captured using mNCANDA were compared with responses from standardized interviews to assess concurrent validity. Reactivity was assessed by evaluating patterns of change in substance use after participants initiated weekly reports via mNCANDA. Quantitative feedback about the app was obtained from the participants. Qualitative interviews were conducted with a subset of participants who used the app for at least one month to obtain feedback on user experience, user-derived explanations of some quantitative results, and suggestions for system improvements. RESULTS The mNCANDA protocol adherence was high (mean response rate 82%, SD 27%) and stable over time across all age groups. The median time to complete each assessment was 51 s (mean response time 1.14, SD 1.03 min). Comparisons between mNCANDA and interview self-reports on recent (previous 30 days) alcohol and cannabis use days demonstrate close agreement (eg, within 1 day of reported use) for most observations. Models used to identify reactivity failed to detect changes in substance use patterns subsequent to enrolling in mNCANDA app assessments (P>.39). Most participants (64/76, 84%) across the age range reported finding the mNCANDA system acceptable. Participants provided recommendations for improving the system (eg, tailoring signaling times). CONCLUSIONS mNCANDA provides a feasible, multi-year, continuous, fine-grained (eg, weekly) assessment of health behaviors designed to minimize respondent burden and provides acceptable regimes for long-term self-reporting of health behaviors. Fine-grained characterization of variability in behaviors over relatively long periods (eg, up to 18 months) may, through the use of mNCANDA, improve our understanding of the relationship between substance use exposure and neurocognitive development.
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Affiliation(s)
- Kevin M Cummins
- Department of Psychology, University of California San Diego, La Jolla, CA, United States
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Ty Brumback
- Department of Psychology, Northern Kentucky University, Highland Heights, KY, CA, United States
| | - Tammy Chung
- Department of Psychiatry, Institute for Health, Healthcare Policy and Aging Research, New Brunswick, NJ, United States
| | - Raeanne C Moore
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Trevor Henthorn
- Department of Music, University of California San Diego, La Jolla, CA, CA, United States
| | - Sonja Eberson
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Alyssa Lopez
- Department of Data Science and Operations, University of Southern California, Los Angeles, CA, United States
| | - Tatev Sarkissyan
- Department of Psychology, California State University Los Angeles, Los Angeles, CA, United States
| | - Kate B Nooner
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC, CA, United States
| | - Sandra A Brown
- Department of Psychology, University of California San Diego, La Jolla, CA, United States
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Susan F Tapert
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States
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