A Systematic Review of Momentary Assessment Designs for Mood and Anxiety Symptoms

Implementation of an Ecological Momentary Assessment (EMA) in Naturalistic Psychotherapy Settings: Qualitative Insights from Patients, Therapists, and Supervisors Perspectives

Ecological momentary assessment (EMA) allows measuring intra-individual processes moment by moment, identifying and modeling, in a naturalistic way, individual levels and changes in different psychological processes. However, active EMA requires a high degree of adherence, as it implies a significant burden for patients. Moreover, there is still no consensus on standardized procedures for implementation. There have been few results in detecting desirable characteristics for the design and implementation of an EMA device. Studies that address these issues from the perspectives of participants in psychotherapeutic processes are needed. To analyze the perspectives of patients, therapists and supervisors on the implementation of an EMA device in a psychotherapeutic treatment for depression. The sample will include eight patients, eleven therapists and five supervisors, taken from a research project that implemented an EMA system for monitoring the dynamics of affectivity at the beginning of psychotherapies for depression. Semi-structured interviews specific to each group are being conducted and analyzed from a qualitative approach based on consensual qualitative research (CQR). Participants reported having a positive evaluation of the study's informational resources and implementation. Difficulties were expressed in responding in the morning hours and the importance of having a customized EMA that is tailored to the needs of the patients was expressed. Furthermore, patients and therapists agreed that the impact of the use of the monitoring system on treatment was neutral or positive. In contrast, patients considered the EMA to be positive for their daily life.

Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review

BACKGROUND

There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet.

OBJECTIVE

This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science.

RESULTS

A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics.

CONCLUSIONS

AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

Accessibility and feasibility of experience sampling methods for mental health research with people with intellectual disability: Scoping of research and stakeholder views

BACKGROUND

Experience sampling may be useful for mental health research with people with intellectual disability, and evidence of the potential benefits is starting to emerge. This multiple-method study identified potential avenues for tailoring this method to the needs of people with intellectual disability.

METHOD

A scoping review was conducted. Five databases were searched for experience sampling studies involving people with intellectual disability. In addition, seven adults with an intellectual disability tested experience sampling apps with standardised questions about mental health and were interviewed about their experiences in semi-structured interviews.

RESULTS

Seven studies were included in the scoping review. Two studies investigated acceptability and feasibility. In the interviews, participants reported on the acceptability, availability, and appropriateness of experience sampling applications.

CONCLUSIONS

There are still important gaps in knowledge about acceptability, availability, and appropriateness of experience sampling for this population. Researchers are recommended to tailor experience sampling applications to the needs and interests of individual users.

Effects of videoconferencing use on momentary changes in disordered eating urges, body dissatisfaction, and mood

The coronavirus disease 2019 (COVID-19) pandemic led to a global surge in videoconferencing use for work/study-related reasons. Although these platforms heighten exposure to one's image, the implications of videoconferencing use on body image and eating concerns remain scantly examined. This study sought to investigate, in an Australian sample, whether videoconferencing for work/study-related reasons predicted increases in body dissatisfaction (BD), urge to engage in disordered eating (DE; restrictive eating, exercise, overeating/purging), and negative mood at the state level. Participants (N = 482, 78.8% women, Mage  = 20.5 years [SD = 5.3]) completed baseline demographic measures, accompanied by an ecological momentary assessment (EMA) of videoconferencing for work/study-related reasons, BD, DE urges, and negative mood six times a day for 7 days via a smartphone application. Most participants (n = 429; 89.0%) reported state-based videoconferencing use during the EMA phase. Consistent with expectations, state-based videoconferencing use was associated with an increase in state-level urges to engage in exercise. However, contrary to predictions, state-based videoconferencing use was linked to a decrease in state-level BD at the next assessment point and failed to predict negative mood and urges to engage in restrictive eating or overeating/purging at the state level. Given the simplified measure of videoconferencing use, the current research is considered preliminary and future replication and extension, using more nuanced measures, is warranted.

Emotion dynamics of clients with test anxiety before and after an imagery-based treatment

BACKGROUND AND OBJECTIVES

Imagery-based techniques have become a promising means in the treatment of test anxiety (TA). Although previous studies have demonstrated the effectiveness of imagery-based treatment, not all clients seem to benefit from it. The present study compares clients' pre- as well as post-treatment emotion dynamics between responders and non-responders. Furthermore, it examines treatment-related changes in emotion dynamics in both subgroups.

METHODS

The results are based on 44 clients suffering from TA who underwent a six-session imagery-based treatment and include Ecological Momentary Assessment (EMA). Emotions were assessed with the Profile of Mood States four times a day over the course of two weeks before and after the treatment. Temporal networks were computed to index emotion dynamics.

RESULTS

Pre-treatment emotion dynamics differed between responders and non-responders. Similarly, post-treatment emotion dynamics differed as well between both groups. Some changes were also observed between pre-treatment and post-treatment networks: for responders, fatigue no longer predicted anger, and depression predicted itself; for non-responders, calmness predicted fatigue, anger, depression, contentment, and anxiety. In addition, fatigue no longer predicted itself and anxiety predicted vigor.

LIMITATIONS

The investigation is marked by several limitations: a liberal inclusion threshold of at least a 50% response to EMA prompts, and a relatively homogenous sample.

CONCLUSION

These results provide first evidence for the idea that emotion dynamics may be associated with response to treatment for TA. Furthermore, effective imagery-based treatments may be tied to changes within these dynamics.

To Use or Not to Use: Exploring Therapists' Experiences with Pre-Treatment EMA-Based Personalized Feedback in the TheraNet Project

BACKGROUND

Using idiographic network models in psychotherapy has been a growing area of interest. However, little is known about the perceived clinical utility of network models. The present study aims to explore therapists' experiences with network model-based feedback within the context of the TheraNet Project.

METHODS

In total, 18 therapists who had received network-based feedback for at least 1 patient at least 2 months prior were invited to retrospective focus groups. The focus group questions related to how participation in the study influenced the therapeutic relationship, how the networks were used, and what might improve their clinical utility. The transcribed focus groups were analyzed descriptively using qualitative content analysis.

RESULTS

Most therapists mentioned using the feedback to support their existingtheir case concept, while fewer therapists discussed the feedback directly with the patients. Several barriers to using the feedback were discussed, as well as various suggestions for how to make it more clinically useful. Many therapists reported skepticism with regards to research in the outpatient training center in general, though they were also all pleasantly surprised by being involved, having their opinions heard, and showing a readiness to adapt research to their needs/abilities.

CONCLUSIONS

This study highlights the gap between researchers' and therapists' perceptions about what useful feedback should look like. The TheraNet therapists' interest in adapting the feedback and building more informative feedback systems signals a general openness to the implementation of clinically relevant research. We provide suggestions for future implementations of network-based feedback systems in the outpatient clinical training center setting.

Evaluating the Effects of Rewards and Schedule Length on Response Rates to Ecological Momentary Assessment Surveys: Randomized Controlled Trials

BACKGROUND

Ecological momentary assessments (EMAs) are short, repeated surveys designed to collect information on experiences in real-time, real-life contexts. Embedding periodic bursts of EMAs within cohort studies enables the study of experiences on multiple timescales and could greatly enhance the accuracy of self-reported information. However, the burden on participants may be high and should be minimized to optimize EMA response rates.

OBJECTIVE

We aimed to evaluate the effects of study design features on EMA response rates.

METHODS

Embedded within an ongoing cohort study (Health@NUS), 3 bursts of EMAs were implemented over a 7-month period (April to October 2021). The response rate (percentage of completed EMA surveys from all sent EMA surveys; 30-42 individual EMA surveys sent/burst) for each burst was examined. Following a low response rate in burst 1, changes were made to the subsequent implementation strategy (SMS text message announcements instead of emails). In addition, 2 consecutive randomized controlled trials were conducted to evaluate the efficacy of 4 different reward structures (with fixed and bonus components) and 2 different schedule lengths (7 or 14 d) on changes to the EMA response rate. Analyses were conducted from 2021 to 2022 using ANOVA and analysis of covariance to examine group differences and mixed models to assess changes across all 3 bursts.

RESULTS

Participants (N=384) were university students (n=232, 60.4% female; mean age 23, SD 1.3 y) in Singapore. Changing the reward structure did not significantly change the response rate (F3,380=1.75; P=.16). Changing the schedule length did significantly change the response rate (F1,382=6.23; P=.01); the response rate was higher for the longer schedule (14 d; mean 48.34%, SD 33.17%) than the shorter schedule (7 d; mean 38.52%, SD 33.44%). The average response rate was higher in burst 2 and burst 3 (mean 50.56, SD 33.61 and mean 48.34, SD 33.17, respectively) than in burst 1 (mean 25.78, SD 30.12), and the difference was statistically significant (F2,766=93.83; P<.001).

CONCLUSIONS

Small changes to the implementation strategy (SMS text messages instead of emails) may have contributed to increasing the response rate over time. Changing the available rewards did not lead to a significant difference in the response rate, whereas changing the schedule length did lead to a significant difference in the response rate. Our study provides novel insights on how to implement EMA surveys in ongoing cohort studies. This knowledge is essential for conducting high-quality studies using EMA surveys.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/ct2/show/NCT05154227.

Predicting real-world emotion and health from spontaneously assessed linguistic distancing using novel scalable technology

Individuals who are better at regulating their emotions have been shown to have better physical and mental health outcomes. One promising emotion regulation strategy is psychological distancing, which involves appraising a stimulus with objectivity or spatial/temporal distance. Language-based psychological distancing (linguistic distancing [LD]) refers to the degree to which one implements psychological distancing naturally via language. A crucial, underexamined mechanism that may account for real-world emotion and health self-reports is spontaneous (i.e., implicit) LD. Using HealthSense, a novel, scalable, mobile health assessment application, we collected lexical transcriptions for personally specific negative and positive events as well as emotion and health-relevant data over 14 days (data collected in 2021) and examined how implicit LD during negative and positive events relates to well-being over time. Primary analyses revealed that higher LD during negative events was associated with lower levels of stress as well as greater emotional and physical well-being within persons. LD during positive events on 1 day predicted greater reports of happiness 2 days later within persons. LD during positive events was associated with fewer symptoms of depression and LD during negative events was associated with greater physical well-being among persons. Exploratory analyses revealed that average depression, rumination, and perceived stress across the 2 weeks were significantly negatively associated with LD during negative events between persons. The present results expand understanding of the relationship between LD and mental and physical health risks and motivate future research on low-burden, scalable interventions involving LD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceiving noise in daily life: How real-time sound characteristics affect personal momentary noise annoyance in various activity microenvironments and times of day

Annoyance is a major health burden induced by environmental noise. However, our understanding of the health impacts of noise is seriously undermined by the fixed contextual unit and limited sound characteristics (e.g., the sound level only) used in noise exposure assessments as well as the stationarity assumption made for exposure-response relationships. To address these limitations, we analyze the complex and dynamic relationships between personal momentary noise annoyance and real-time noise exposure in various activity microenvironments and times of day, taking into account individual mobility, multiple sound characteristics and nonstationary relationships. Using real-time mobile sensing, we collected individual data of momentary noise annoyance, real-time noise exposure as well as daily activities and travels in Hong Kong. A new sound characteristic, namely sound increment, is defined to capture the sudden increase in sound level over time and is used along with the sound level to achieve a multi-faceted assessment of personal real-time noise exposure at the moment of annoyance responses. Further, the complex noise exposure-annoyance relationships are learned using logistic regression and random forest models while controlling the effects of daily activity microenvironments, individual sociodemographic attributes and temporal contexts. The results indicate that the effects of the real-time sound level and sound increment on personal momentary noise annoyance are nonlinear, despite the overall significant and positive impacts, and different sound characteristics can produce a joint effect on annoyance. We also find that the daily activity microenvironments and individual sociodemographic attributes can affect noise annoyance and its relationship with different sound characteristics to varying degrees. Due to the temporal changes in daily activities and travels, the noise exposure-annoyance relationships can also vary over different times of the day. These findings can inform both local governments and residents with scientific evidence to promote the creation of acoustically comfortable living environments.

Specificity of affective dynamics of bipolar and major depressive disorder

OBJECTIVE

Here, we examine whether the dynamics of the four dimensions of the circumplex model of affect assessed by ecological momentary assessment (EMA) differ among those with bipolar disorder (BD) and major depressive disorder (MDD).

METHODS

Participants aged 11-85 years (n = 362) reported momentary sad, anxious, active, and energetic dimensional states four times per day for 2 weeks. Individuals with lifetime mood disorder subtypes of bipolar-I, bipolar-II, and MDD derived from a semistructured clinical interview were compared to each other and to controls without a lifetime history of psychiatric disorders. Random effects from individual means, inertias, innovation (residual) variances, and cross-lags across the four affective dimensions simultaneously were derived from multivariate dynamic structural equation models.

RESULTS

All mood disorder subtypes were associated with higher levels of sad and anxious mood and lower energy than controls. Those with bipolar-I had lower average activation, and lower energy that was independent of activation, compared to MDD or controls. However, increases in activation were more likely to perpetuate in those with bipolar-I. Bipolar-II was characterized by higher lability of sad and anxious mood compared to bipolar-I and controls but not MDD. Compared to BD and controls, those with MDD exhibited cross-augmentation of sadness and anxiety, and sadness blunted energy.

CONCLUSION

Bipolar-I is more strongly characterized by activation and energy than sad and anxious mood. This distinction has potential implications for both specificity of intervention targets and differential pathways underlying these dynamic affective systems. Confirmation of the longer term stability and generalizability of these findings in future studies is necessary.

Network analysis of ecological momentary assessment identifies frustration as a central node in irritability

BACKGROUND

Irritability presents transdiagnostically, commonly occurring with anxiety and other mood symptoms. However, little is known about the temporal and dynamic interplay among irritability-related clinical phenomena. Using a novel network analytic approach with smartphone-based ecological momentary assessment (EMA), we examined how irritability and other anxiety and mood symptoms were connected.

METHODS

Sample included 152 youth ages 8-18 years (M ± SD = 12.28 ± 2.53; 69.74% male; 65.79% White) across several diagnostic groups enriched for irritability including disruptive mood dysregulation disorder (n = 34), oppositional defiant disorder (n = 9), attention-deficit/hyperactivity disorder (n = 47), anxiety disorder (n = 29), and healthy comparisons (n = 33). Participants completed EMA on irritability-related constructs and other mood and anxiety symptoms three times a day for 7 days. EMA probed symptoms on two timescales: "since the last prompt" (between-prompt) versus "at the time of the prompt" (momentary). Irritability was also assessed using parent-, child- and clinician-reports (Affective Reactivity Index; ARI), following EMA. Multilevel vector autoregressive (mlVAR) models estimated a temporal, a contemporaneous within-subject and a between-subject network of symptoms, separately for between-prompt and momentary symptoms.

RESULTS

For between-prompt symptoms, frustration emerged as the most central node in both within- and between-subject networks and predicted more mood changes at the next timepoint in the temporal network. For momentary symptoms, sadness and anger emerged as the most central node in the within- and between-subject network, respectively. While anger was positively related to sadness within individuals and measurement occasions, anger was more broadly positively related to sadness, mood lability, and worry between/across individuals. Finally, mean levels, not variability, of EMA-indexed irritability were strongly related to ARI scores.

CONCLUSIONS

This study advances current understanding of symptom-level and temporal dynamics of irritability. Results suggest frustration as a potential clinically relevant treatment target. Future experimental work and clinical trials that systematically manipulate irritability-related features (e.g. frustration, unfairness) will elucidate the causal relations among clinical variables.

Measuring affect in daily life: A multilevel psychometric evaluation of the PANAS-X across four ecological momentary assessment samples

While there is strong evidence for the psychometric reliability of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X) in cross-sectional studies, the between- and within-person psychometric performance of the PANAS-X in an intensive longitudinal framework is less understood. As affect is thought to be dynamic and responsive to context, this study investigated the multilevel reliability of PANAS-X Positive Affect, Negative Affect, Fear, Sadness, and Hostility scales. Generalizability theory and structural equation modeling techniques (coefficient ω) were employed in four ecological momentary assessment samples (N = 309; 41,261 reports). Results demonstrate that the PANAS-X scales, including short versions of the Positive and Negative Affect scales, can reliably detect between-person differences. PANAS-X scales also were able to reliably measure within-person change, though these estimates may be impacted by scale content and study design. These results support the use of the PANAS-X in daily life research to intensively measure affect in the natural environment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Momentary links between adolescents' social media use and social experiences and motivations: Individual differences by peer susceptibility

This longitudinal ecological momentary assessment study examined whether adolescents' use of social media to interact with peers relates to their experiences of social connectedness, social craving, and sensation seeking on an hourly level. Further, we investigated whether these associations differ for adolescents who were nominated by their peers as more or less susceptible to social influences, because highly susceptible youth may be more strongly impacted by social media due to heightened focus on peer behaviors and social feedback. The sample was 212 adolescents in the southeastern United States (Mage = 15 years; range 14 to 17; 56.2% female; 40% White, 28% Latinx, 26% African American, 15% mixed/other race). Controlling for both daily and between-subjects effects, we found a consistent pattern of hourly-level results that were robust to sensitivity analyses. When highly susceptible adolescents used social media to interact with peers in the last hour, they felt less socially connected to others and more strongly craved social connections and novel sensations. Youth who are particularly sensitive to social input from peers may feel less connected to others and crave more connections and exciting stimuli within 1 hr after using social media to interact with peers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ecological momentary assessment of mind-wandering: meta-analysis and systematic review

Mind-wandering (MW) is a universal human phenomenon and revealing its nature contributes to understanding consciousness. The ecological momentary assessment (EMA), in which subjects report a momentary mental state, is a suitable method to investigate MW in a natural environment. Previous studies employed EMA to study MW and attempted to answer the most fundamental question: How often do we let our minds wander? However, reported MW occupancies vary widely among studies. Further, while some experimental settings may induce bias in MW reports, these designs have not been explored. Therefore, we searched PubMed and Web of Science for articles published until the end of 2020 and systematically reviewed 25 articles, and performed meta-analyses on 17 of them. Our meta-analysis found that people spend 34.504% of daily life in mind-wandering, and meta-regression revealed that using subject smartphones for EMA, frequent sampling, and long experimental duration significantly affect MW reports. This result indicates that EMA using subject smartphones may tend to collect sampling under habitual smartphone use. Furthermore, these results indicate the existence of reactivity, even in MW research. We provide fundamental knowledge of MW and discuss rough standards for EMA settings in future MW studies.

Novel digital methods for gathering intensive time series data in mental health research: scoping review of a rapidly evolving field

Recent technological advances enable the collection of intensive longitudinal data. This scoping review aimed to provide an overview of methods for collecting intensive time series data in mental health research as well as basic principles, current applications, target constructs, and statistical methods for this type of data.In January 2021, the database MEDLINE was searched. Original articles were identified that (1) used active or passive data collection methods to gather intensive longitudinal data in daily life, (2) had a minimum sample size of N ⩾ 100 participants, and (3) included individuals with subclinical or clinical mental health problems.In total, 3799 original articles were identified, of which 174 met inclusion criteria. The most widely used methods were diary techniques (e.g. Experience Sampling Methodology), various types of sensors (e.g. accelerometer), and app usage data. Target constructs included affect, various symptom domains, cognitive processes, sleep, dysfunctional behaviour, physical activity, and social media use. There was strong evidence on feasibility of, and high compliance with, active and passive data collection methods in diverse clinical settings and groups. Study designs, sampling schedules, and measures varied considerably across studies, limiting the generalisability of findings.Gathering intensive longitudinal data has significant potential to advance mental health research. However, more methodological research is required to establish and meet critical quality standards in this rapidly evolving field. Advanced approaches such as digital phenotyping, ecological momentary interventions, and machine-learning methods will be required to efficiently use intensive longitudinal data and deliver personalised digital interventions and services for improving public mental health.

Sleep influences daily suicidal ideation through affective reactivity to interpersonal events among high-risk adolescents and young adults

BACKGROUND

Identifying proximal risk factors for suicidal ideation that are modifiable and relevant for adolescents and young adults is critical for suicide prevention. This study used an intensive monitoring approach to examine whether objectively- and subjectively- measured sleep characteristics predict next-day suicidal ideation occurrence and intensity through affective reactivity to interpersonal events in young people at high risk for suicide.

METHODS

Participants included 59 (13-23 years; 76% White; 75% female) adolescents and young adults undergoing intensive outpatient program treatment for depression and suicidality. Participants completed daily ratings of suicidal ideation, sleep quality, and affective reactivity to positive and negative interpersonal events for up to 3 months (M = 56 days, SD = 24.13). Actigraphy captured behavioral sleep duration and timing. Multilevel modeling was used to evaluate within-person fluctuations in sleep and affective reactivity as predictors of suicidal ideation, and multilevel mediation tested the indirect effects of sleep on suicidal ideation via affective reactivity to interpersonal events.

RESULTS

Results indicate significant indirect effects of objectively measured sleep duration and subjective sleep quality on next-day suicidal ideation via affective reactivity to negative and positive interpersonal events, respectively. Shorter-than-usual sleep predicted the presence and intensity of next-day suicidal ideation via heightened affective reactivity to negative interpersonal events. Worse sleep quality than usual predicted next-day suicidal ideation via reduced affective reactivity to positive interpersonal events.

CONCLUSIONS

Affectivity reactivity is a proximal mechanism through which sleep indices may influence risk for suicidal thinking on a daily basis. Findings highlight the utility of targeting sleep and emotion regulation in suicide prevention among adolescents and young adults at high-risk for suicide.

Real-time assessment of positive and negative affective fluctuations and mood lability in a transdiagnostic sample of youth

BACKGROUND

Emotional lability, defined as rapid and/or intense affect fluctuations, is associated with pediatric psychopathology. Although numerous studies have examined labile mood in clinical groups, few studies have used real-time assessments in a well-characterized transdiagnostic sample, and no prior study has included participants with disruptive mood dysregulation disorder (DMDD). The present study leverages ecological momentary assessment (EMA) to assess emotional lability in a transdiagnostic pediatric sample.

METHODS

One hundred thirty participants ages 8-18 with primary diagnoses of DMDD, attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder (ANX), or healthy volunteers completed a previously validated 1-week EMA protocol. Clinicians determined diagnoses based on semi-structured interviews and assessed levels of functional impairment. Participants reported momentary affective states and mood change. Composite scores of fluctuations in positive and negative affect were generated. Affect fluctuations were compared between diagnostic groups and tested for their association with functional impairment.

RESULTS

Diagnostic groups differed in levels of negative and positive emotional lability. DMDD patients demonstrated the highest level of labile mood compared with other groups. Emotional lability was associated with global impairment in the whole sample.

CONCLUSIONS

Both positive and negative emotional lability is salient in pediatric psychopathology and is associated with functional impairment, particularly in DMDD youth.

The role of digital tools in providing youth mental health: results from an international multi-center study

Since the traditional mental health system showed significant limitations in the early identification, diagnosis and treatment of the current new youth psychopathological trajectories, by substantially failing in targeting the needs of the current young generation, there is the demand to redesign and digitally adapt youth mental health care and systems. Indeed, the level of digital literacy and the level of digital competency and knowledge in the field of digital psychiatry is still under-investigated among mental health professionals, particularly in youth mental health. Therefore, we aimed at: (a) carrying out a post-hoc analysis of an international multi-centre study, to investigate the opinions of mental health professionals regarding the feasibility, efficacy and clinical experience in delivering digital mental health interventions (DMHIs) in youths; (b) providing a comprehensive overview on the integrated digitally-based youth mental health care models and innovations. Mental health professionals declared the lack of a formal training in digital psychiatry, particularly in youth mental health. Subjects who received a formal theoretical/practical training on DMHIs displayed a statistical trend towards a positive feasibility of digital psychiatry in youth mental health (p = 0.053) and a perceived increased efficacy of digital psychiatry in youths (p = 0.051). Respondents with higher Digital Psychiatry Opinion (DPO) scores reported a positive perceived feasibility of DMHIs in youths (p < 0.041) and are more prone to deliver DMHIs to young people (p < 0.001). Respondents with higher knowledge scores (KS) declared that DMHIs are more effective in youth mental health (p < 0.001). Overall, the digitalisation indeed allowed young people to keep in touch with a mental health professional, facilitating a more dynamic and fluid mental health care access and monitoring, generally preferred and considered more feasible by post-Millennial youngsters. Accordingly, our findings demonstrated that mental health professionals are more prone to offer DMHIs in youth mental health, particularly whether previously trained and knowledgeable on the topic.

Emotion Regulation Flexibility and Electronic Patient-Reported Outcomes: A Framework for Understanding Symptoms and Affect Dynamics in Pediatric Psycho-Oncology

Simple Summary

The individual’s ability to conceive and regulate the broad spectrum of their human emotions is closely linked to their mental health. The implications of a serious disease such as cancer represent an extraordinary burden to these internal coping mechanisms, especially in the case of young patients. Regarding their well-being and support, it is therefore of particular interest for caregivers to be able to follow the dynamics of the patient’s emotional world and perceptions. Technical progress enables new possibilities for data collection through tools for digital patient self-reports while simultaneously creating new challenges. Within the scope of this article, we provide an overview of the literature on this topic, outlining the current strengths and weaknesses and possible perspectives on digital aids, especially in terms of capturing the flexibility, fluctuations and early detection of symptom changes.

Abstract

Emotion dysregulation is regarded as a driving mechanism for the development of mental health problems and psychopathology. The role of emotion regulation (ER) in the management of cancer distress and quality of life (QoL) has recently been recognized in psycho-oncology. The latest technological advances afford ways to assess ER, affective experiences and QoL in child, adolescent and young adult (CAYA) cancer patients through electronic patient-reported outcomes (ePRO) in their daily environment in real-time. Such tools facilitate ways to study the dynamics of affect and the flexibility of ER. However, technological advancement is not risk-free. We critically review the literature on ePRO in cancer existing models of ER in pediatric psycho-oncology and analyze strength, weaknesses, opportunities and threats of ePRO with a focus on CAYA cancer research and care. Supported by personal study-based experiences, this narrative review serves as a foundation to propose a novel methodological and metatheoretical framework based on: (a) an extended notion of ER, which includes its dynamic, adaptive and flexible nature and focuses on processes and conditions rather than fixed categorical strategies; (b) ePRO as a means to measure emotion regulation flexibility and affect dynamics; (c) identifying early warning signals for symptom change via ePRO and building forecasting models using dynamical systems theory.

The Experience Sampling Method in Monitoring Social Interactions Among Children and Adolescents in School: A Systematic Literature Review

Background

The experience sampling method (ESM) is an increasingly popular data collection method to assess interpersonal dynamics in everyday life and emotions contextualized in real-world settings. As primary advantages of ESM sampling strategies include minimization of memory biases, maximization of ecological validity, and hypothesis testing at the between- and within-person levels, ESM is suggested to be appropriate for studying the daily lives of educational actors. However, ESM appears to be underutilized in education research. We, thus, aimed to systematically evaluate the methodological characteristics and quality of published ESM studies of social interactions among children and adolescents in school settings, as well as to explore how much variance in social interaction variables could be attributed to the within-person level.

Method

Using Academic Search Complete, APA PsycINFO, APA PsycArticles, ProQuest, Web of Science, Wiley Online Library, and SAGE Journals, and in accordance with PRISMA guidelines and pre-defined eligibility criteria, we conducted a systematic literature search of experience sampling studies up to November 2020. To assess methodological quality, we used a modified checklist for reporting of ESM studies.

Results

Of the originally 2 413 identified studies, a final 52 experience sampling studies were included in the present review. Findings on sample and study design characteristics generally revealed wide variability. Even if high-quality studies were associated with higher scores on the training of participants in using the ESM procedure, and use of incentives, these design strategies did not reveal a statistically significant impact on compliance. The intraclass correlation coefficient was reported in nine studies and on average 58% of the variance in social interaction variables could be attributed to within-person fluctuation between timepoints.

Conclusion

The current study is the first to systematically review ESM-based studies on social interactions among children and adolescents in the school context. These observations suggest that ESM is a potentially favorable technique for extracting complex social phenomena in real-world settings. We hope that this review will contribute to improving the quality assessment of ESM studies as well as to inform and guide future experience sampling studies, particularly regarding social phenomena with children and adolescents in educational settings.

Sustained threat and phasic fear in the laboratory and cognitive-emotional processes of anxiety in everyday life - An ambulatory assessment study

Fear is a phasic state of apprehension to an imminent threat, whereas anxiety is a more sustained state of expecting a potential threat leading to tension and worry. The NPU-threat test is a laboratory startle paradigm allowing a reliable and valid assessment of both, fear- and anxiety-potentiated reactions. It is suggested to differentiate between anxiety disorders, but little is known on associations with everyday life experiences of cognitive-emotional processes regarding anxiety in non-clinical samples. In the present project, the NPU-threat test was applied in three studies with (1) unselected healthy individuals, (2) participants with extreme manifestations of trait anxiety (low vs. high) and (3) individuals preparing for a high-stakes exam. Self-reported states of emotionality and worry were assessed during a four-day ambulatory assessment (AA). Overall, NPU-threat test measures did not significantly differ between studies, while the AA dependent measures were sufficiently sensitive to capture differences between groups. However, there was no significant association between psychophysiological measures of the NPU-threat test and AA state measures across participants. In participants recruited for low vs. high trait anxiety we found an association with AA worry and emotionality, but no interaction with potentiated startle. The present findings do not support the idea of a link between our laboratory biomarker and adaptive regulation of cognitive-emotional states in everyday life in healthy individuals. We speculate that an association between laboratory physiological measures and everyday experience of anxious states may be detectable in clinical samples.

A Data-Driven Clustering Method for Discovering Profiles in the Dynamics of Major Depressive Disorder Using a Smartphone-Based Ecological Momentary Assessment of Mood

BACKGROUND

Although major depressive disorder (MDD) is characterized by a pervasive negative mood, research indicates that the mood of depressed patients is rarely entirely stagnant. It is often dynamic, distinguished by highs and lows, and it is highly responsive to external and internal regulatory processes. Mood dynamics can be defined as a combination of mood variability (the magnitude of the mood changes) and emotional inertia (the speed of mood shifts). The purpose of this study is to explore various distinctive profiles in real-time monitored mood dynamics among MDD patients in routine mental healthcare.

METHODS

Ecological momentary assessment (EMA) data were collected as part of the cross-European E-COMPARED trial, in which approximately half of the patients were randomly assigned to receive the blended Cognitive Behavioral Therapy (bCBT). In this study a subsample of the bCBT group was included (n = 287). As part of bCBT, patients were prompted to rate their current mood (on a 1-10 scale) using a smartphone-based EMA application. During the first week of treatment, the patients were prompted to rate their mood on three separate occasions during the day. Latent profile analyses were subsequently applied to identify distinct profiles based on average mood, mood variability, and emotional inertia across the monitoring period.

RESULTS

Overall, four profiles were identified, which we labeled as: (1) "very negative and least variable mood" (n = 14) (2) "negative and moderate variable mood" (n = 204), (3) "positive and moderate variable mood" (n = 41), and (4) "negative and highest variable mood" (n = 28). The degree of emotional inertia was virtually identical across the profiles.

CONCLUSIONS

The real-time monitoring conducted in the present study provides some preliminary indications of different patterns of both average mood and mood variability among MDD patients in treatment in mental health settings. Such varying patterns were not found for emotional inertia.