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Bartels SL, van Zelst C, Melo Moura B, Daniëls NE, Simons CJ, Marcelis M, Bos FM, Servaas MN. Feedback based on experience sampling data: Examples of current approaches and considerations for future research. Heliyon 2023; 9:e20084. [PMID: 37809510 PMCID: PMC10559801 DOI: 10.1016/j.heliyon.2023.e20084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Methodologies such as the Experience Sampling Method (ESM) or Ecological Momentary Assessment allow the gathering of fine-graded, dynamic, personal data within a patient's daily life. Currently, it is studied whether feedback based on experience sampling data (ESM-based feedback) can be used as a clinical tool to inform shared decision-making in clinical practice. Although the potential of feedback is recognized, little is known on how to generate, use, and implement it. This article (i) presents n = 15 ongoing ESM projects within the Belgian-Dutch network for ESM research wherein ESM-based feedback is provided to various patient populations, and (ii) summarizes qualitative data on experiences with ESM-based feedback of researchers (n = 8) with extensive expertise with ESM (average of 10 years) involved in these ongoing studies. The following aspects appear to be of relevance when providing ESM-based feedback: training for healthcare professionals and researchers, the use of online interfaces and graphical visualizations to present data, and interacting with patients in a face-to-face setting when discussing the contextual relevance and potential implications. Prospectively, research may build on these aspects and create coherent consensus-based guidelines for the use of ESM-based feedback.
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Affiliation(s)
- Sara Laureen Bartels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Catherine van Zelst
- Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands
- GGzE Institute for Mental Health Care Eindhoven, Eindhoven, the Netherlands
| | - Bernardo Melo Moura
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Institute of Pharmacology and Neurosciences, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Universidade Católica Portuguesa, Faculdade de Medicina, Portugal
| | - Naomi E.M. Daniëls
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Claudia J.P. Simons
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- GGzE Institute for Mental Health Care Eindhoven, Eindhoven, the Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- GGzE Institute for Mental Health Care Eindhoven, Eindhoven, the Netherlands
| | - Fionneke M. Bos
- Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michelle N. Servaas
- Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Bos FM, van der Krieke L, Wichers M, Bruggeman R, Snippe E. [Ecological momentary assessment as a clinical tool in psychiatry: promises, pitfalls, and possibilities]. Tijdschr Psychiatr 2023; 65:54-59. [PMID: 36734692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ecological momentary assessment (EMA) is a promising method to gain insight into the daily lives of people with mental disorders. EMA can be used to monitor mood, symptoms, and experiences multiple times per day. Using advanced statistical methods, such as network analysis, as EMA feedback might result in novel insights that are relevant to psychiatric care. AIM To investigate the promise, pitfalls, and possibilities of EMA and network analysis for psychiatric care. METHOD Empirical network studies, reviews, and qualitative research were employed to investigate the state of research and the perspectives of patients and clinicians on EMA and network analysis. Furthermore, an empirical study will be discussed, in which twenty patients with bipolar disorders completed five EMA diaries per day for four months within treatment. RESULTS Studies using network analysis demonstrated conflicting results. Qualitative research indicated that bipolar patients and clinicians are aware of the added benefit of EMA for psychiatric care, especially for improving insight and self-management. At the same time, EMA was seen as burdensome. Personalization and integration with existing treatment protocols emerged as necessary requirements for adequate implementation of EMA in psychiatric care. CONCLUSION EMA can have added value for psychiatric care, provided it is adequately implemented. BACKGROUND Ecological momentary assessment (EMA) is a promising method to gain insight into the daily lives of people with mental disorders. EMA can be used to monitor mood, symptoms, and experiences multiple times per day. Using advanced statistical methods, such as network analysis, as EMA feedback might result in novel insights that are relevant to psychiatric care. AIM To investigate the promise, pitfalls, and possibilities of EMA and network analysis for psychiatric care. METHOD Empirical network studies, reviews, and qualitative research were employed to investigate the state of research and the perspectives of patients and clinicians on EMA and network analysis. Furthermore, an empirical study will be discussed, in which twenty patients with bipolar disorders completed five EMA diaries per day for four months within treatment. RESULTS Studies using network analysis demonstrated conflicting results. Qualitative research indicated that bipolar patients and clinicians are aware of the added benefit of EMA for psychiatric care, especially for improving insight and self-management. At the same time, EMA was seen as burdensome. Personalization and integration with existing treatment protocols emerged as necessary requirements for adequate implementation of EMA in psychiatric care. CONCLUSION EMA can have added value for psychiatric care, provided it is adequately implemented.
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Piot M, Mestdagh M, Riese H, Weermeijer J, Brouwer JM, Kuppens P, Dejonckheere E, Bos FM. Practitioner and researcher perspectives on the utility of ecological momentary assessment in mental health care: A survey study. Internet Interv 2022; 30:100575. [PMID: 36193339 PMCID: PMC9526140 DOI: 10.1016/j.invent.2022.100575] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/05/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is a scientific self-monitoring method to capture individuals' daily life experiences. Early on, EMA has been suggested to have the potential to improve mental health care. However, it remains unclear if and how EMA should be implemented. This requires an in-depth investigation of how practitioners and researchers view the implementation of EMA. OBJECTIVE Explore the perspectives of mental health practitioners and EMA researchers on the utility of EMA for mental health care. METHODS Practitioners (n = 89; psychiatrists, psychologists, psychiatric nurses) and EMA researchers (n = 62) completed a survey about EMA in clinical practice. This survey addressed EMA goals for practitioner and patient, requirements regarding clinical use of EMA, and (dis)advantages of EMA compared to treatment-as-usual. t-Tests were used to determine agreement with each statement and whether practitioners' and researchers' views differed significantly. Linear regression was used to explore predictors of goals and preferences (e.g., EMA experience). RESULTS Practitioners and researchers considered EMA to be a useful clinical tool for diverse stages of care. They indicated EMA to be most useful for gaining insight into the context specificity of symptoms (55.0 %), whereas receiving alerts when symptoms increase was rated the least useful (11.3 %, alerts is in 95 % of bootstrap iterations between rank 8 and 10). Compared to treatment-as-usual, EMA was considered easier to use (M = 4.87, t = 5.30, p < .001) and interpret (M = 4.52, t = 3.61, p < .001), but also more burdensome for the patient (M = 4.48, t = 3.17, p < .001). Although participants preferred personalization of the EMA diary, they also suggested that EMA should cost practitioners and patients limited time. The preference for creating personalized EMA was related to the level of experience with EMA. Finally, they highlighted the need for practitioner training and patient full-time access to the EMA feedback. CONCLUSIONS This survey study demonstrated that practitioners and researchers expect EMA to have added value for mental health care. Concrete recommendations for implementation of EMA are formulated. This may inform the development of specific clinical applications and user-friendly EMA software.
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Affiliation(s)
- Maarten Piot
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Corresponding author at: Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Leuven 3000, Belgium.
| | - Merijn Mestdagh
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
| | - Jeroen Weermeijer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jannie M.A. Brouwer
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
| | - Peter Kuppens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Egon Dejonckheere
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Department Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg, Belgium
| | - Fionneke M. Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
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Bos FM, von Klipstein L, Emerencia AC, Veermans E, Verhage T, Snippe E, Doornbos B, Hadders-Prins G, Wichers M, Riese H. A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application. JMIR Ment Health 2022; 9:e36430. [PMID: 35943762 PMCID: PMC9399881 DOI: 10.2196/36430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed. OBJECTIVE This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers). METHODS The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted. RESULTS The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations. CONCLUSIONS PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lino von Klipstein
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ando C Emerencia
- Research Support, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Erwin Veermans
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom Verhage
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Grietje Hadders-Prins
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Bos FM, Schreuder MJ, George SV, Doornbos B, Bruggeman R, van der Krieke L, Haarman BCM, Wichers M, Snippe E. Anticipating manic and depressive transitions in patients with bipolar disorder using early warning signals. Int J Bipolar Disord 2022; 10:12. [PMID: 35397076 PMCID: PMC8994809 DOI: 10.1186/s40345-022-00258-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background In bipolar disorder treatment, accurate episode prediction is paramount but remains difficult. A novel idiographic approach to prediction is to monitor generic early warning signals (EWS), which may manifest in symptom dynamics. EWS could thus form personalized alerts in clinical care. The present study investigated whether EWS can anticipate manic and depressive transitions in individual patients with bipolar disorder. Methods Twenty bipolar type I/II patients (with ≥ 2 episodes in the previous year) participated in ecological momentary assessment (EMA), completing five questionnaires a day for four months (Mean = 491 observations per person). Transitions were determined by weekly completed questionnaires on depressive (Quick Inventory for Depressive Symptomatology Self-Report) and manic (Altman Self-Rating Mania Scale) symptoms. EWS (rises in autocorrelation at lag-1 and standard deviation) were calculated in moving windows over 17 affective and symptomatic EMA states. Positive and negative predictive values were calculated to determine clinical utility. Results Eleven patients reported 1–2 transitions. The presence of EWS increased the probability of impending depressive and manic transitions from 32-36% to 46–48% (autocorrelation) and 29–41% (standard deviation). However, the absence of EWS could not be taken as a sign that no transition would occur in the near future. The momentary states that indicated nearby transitions most accurately (predictive values: 65–100%) were full of ideas, worry, and agitation. Large individual differences in the utility of EWS were found. Conclusions EWS show theoretical promise in anticipating manic and depressive transitions in bipolar disorder, but the level of false positives and negatives, as well as the heterogeneity within and between individuals and preprocessing methods currently limit clinical utility. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00258-4.
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Affiliation(s)
- Fionneke M Bos
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Marieke J Schreuder
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandip V George
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Computer Science , University College London , London, United Kingdom
| | - Bennard Doornbos
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Lian van der Krieke
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bartholomeus C M Haarman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Wichers M, Riese H, Hodges TM, Snippe E, Bos FM. A Narrative Review of Network Studies in Depression: What Different Methodological Approaches Tell Us About Depression. Front Psychiatry 2021; 12:719490. [PMID: 34777038 PMCID: PMC8581034 DOI: 10.3389/fpsyt.2021.719490] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
The network theory of psychopathology proposes that mental disorders arise from direct interactions between symptoms. This theory provides a promising framework to understand the development and maintenance of mental disorders such as depression. In this narrative review, we summarize the literature on network studies in the field of depression. Four methodological network approaches are distinguished: (i) studies focusing on symptoms at the macro-level vs. (ii) on momentary states at the micro-level, and (iii) studies based on cross-sectional vs. (iv) time-series (dynamic) data. Fifty-six studies were identified. We found that different methodological approaches to network theory yielded largely inconsistent findings on depression. Centrality is a notable exception: the majority of studies identified either positive affect or anhedonia as central nodes. To aid future research in this field, we outline a novel complementary network theory, the momentary affect dynamics (MAD) network theory, to understand the development of depression. Furthermore, we provide directions for future research and discuss if and how networks might be used in clinical practice. We conclude that more empirical network studies are needed to determine whether the network theory of psychopathology can indeed enhance our understanding of the underlying structure of depression and advance clinical treatment.
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Affiliation(s)
- Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Taylor M Hodges
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Fionneke M Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands.,University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, Netherlands
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Bos FM, Snippe E, Bruggeman R, Doornbos B, Wichers M, van der Krieke L. Recommendations for the use of long-term experience sampling in bipolar disorder care: a qualitative study of patient and clinician experiences. Int J Bipolar Disord 2020; 8:38. [PMID: 33258015 PMCID: PMC7704990 DOI: 10.1186/s40345-020-00201-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Self-monitoring has been shown to improve the self-management and treatment of patients with bipolar disorder. However, current self-monitoring methods are limited to once-daily retrospectively assessed mood, which may not suit the rapid mood fluctuations in bipolar disorder. The experience sampling method (ESM), which assesses mood in real-time several times a day, may overcome these limitations. This study set out to assess the experiences of patients and clinicians with the addition of ESM monitoring, real-time alerts, and personalized feedback to clinical care. Participants were twenty patients with bipolar disorder type I/II and their clinicians. For four months, patients completed five ESM assessments per day on mood, symptoms, and activities. Weekly symptom questionnaires alerted patients and clinicians to potential episodes. After the monitoring, a personalized feedback report based on the patient’s data was discussed between patient and clinician. Three months later, patient and clinician were both interviewed. Results Thematic analysis of the transcripts resulted in four themes: perceived effects of the monitoring, alerts, and feedback, and recommendations for implementation of ESM. ESM was perceived as helping patients to cope better with their disorder by increasing awareness, offering new insights, and encouraging life style adjustments. ESM was further believed to facilitate communication between patient and clinician and to lead to new treatment directions. However, high assessment burden and pre-occupation with negative mood and having a disorder were also described. Patients and clinicians advocated for increased personalization and embedding of ESM in care. Conclusions This study demonstrates that long-term ESM monitoring, alerts, and personalized feedback are perceived as beneficial to the treatment and self-management of patients with bipolar disorder. Future research should further test the clinical utility of ESM. Clinically relevant feedback and technology need to be developed to enable personalized integration of ESM in clinical care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lian van der Krieke
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bos FM, Snippe E, Bruggeman R, Wichers M, van der Krieke L. Insights of Patients and Clinicians on the Promise of the Experience Sampling Method for Psychiatric Care. Psychiatr Serv 2019; 70:983-991. [PMID: 31434558 DOI: 10.1176/appi.ps.201900050] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This qualitative study aimed to map the relevance of the experience sampling method (ESM) for psychiatric practice and identify barriers and facilitators for implementation, as perceived by patients and clinicians. METHODS Participants were 22 patients with various diagnoses and 21 clinicians (e.g., psychiatrists, psychologists) who participated in interviews or focus groups. Using Atlas.TI, the authors conducted qualitative thematic analysis to analyze the transcripts, resulting in four themes: applications, advantages, undesirable effects, and requirements for implementation of ESM in care. RESULTS Clinicians and patients believed ESM could be relevant in every phase of care to increase patients' awareness, insight, and self-management; personalize interventions; and alert patients to rising symptoms. Further, ESM was expected to improve the patient-clinician relationship; lead to objective, personalized, reliable and visual data; and increase efficiency of care. However, participants warned against high assessment burden and potential symptom worsening. CONCLUSIONS This study provides first evidence that the potential of ESM is recognized by both patients and clinicians. Key recommendations for optimal implementation of ESM in psychiatric care include flexible application of ESM, collaboration between patient and clinician, regular evaluation, awareness of negative reactivity, availability to patients with different psychiatric syndromes, and implementation by an interdisciplinary team of patients, clinicians, researchers, and information technology specialists.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lian van der Krieke
- Rob Giel Research Center (Bos, Bruggeman, van der Krieke) and Interdisciplinary Center Psychopathology and Emotion Regulation (Bos, Snippe, Wichers, van der Krieke), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Bos FM, Blaauw FJ, Snippe E, van der Krieke L, de Jonge P, Wichers M. Exploring the emotional dynamics of subclinically depressed individuals with and without anhedonia: An experience sampling study. J Affect Disord 2018; 228:186-193. [PMID: 29253685 DOI: 10.1016/j.jad.2017.12.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/13/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Anhedonia has been linked to worse prognosis of depression. The present study aimed to construct personalized models to elucidate the emotional dynamics of subclinically depressed individuals with versus without symptoms of anhedonia. METHODS Matched subclinically depressed individuals with and without symptoms of anhedonia (N = 40) of the HowNutsAreTheDutch sample completed three experience sampling methodology assessments per day for 30 days. For each individual, the impact of physical activity, stress experience, and high/low arousal PA/NA on each other was estimated through automated impulse response function analysis (IRF). These individual IRF associations were combined to compare anhedonic versus non-anhedonic individuals. RESULTS Physical activity had low impact on affect in both groups. In non-anhedonic individuals, stress experience increased NA and decreased PA and physical activity more strongly. In anhedonic individuals, PA high arousal showed a diminished favorable impact on affect (increasing NA/stress experience, decreasing PA/physical activity). Finally, large heterogeneity in the personalized models of emotional dynamics were found. LIMITATIONS Stress experience was measured indirectly by assessing level of distress; the timeframe in between measurements was relatively long with 6h; and only information on one of the two hallmarks of anhedonia, loss of interest, was gathered. CONCLUSIONS Our results suggest different pathways of emotional dynamics underlie depressive symptomatology. Subclinically depressed individuals with anhedonic complaints are more strongly characterized by diminished favorable impact of PA high arousal and heightened NA reactivity, whereas subclinically depressed individuals without these anhedonic complaints seem more characterized by heightened stress reactivity. The automatically generated personalized models may offer patient-specific insights in emotional dynamics, which may show clinical relevance.
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Affiliation(s)
- F M Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands.
| | - F J Blaauw
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands; Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands; Johann Bernoulli Institute for Mathematics and Computer Science (JBI), Distributed Systems Group, University of Groningen, Groningen, The Netherlands
| | - E Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - L van der Krieke
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - P de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands; Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - M Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
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Bos FM, Fried EI, Hollon SD, Bringmann LF, Dimidjian S, DeRubeis RJ, Bockting CLH. Cross-sectional networks of depressive symptoms before and after antidepressant medication treatment. Soc Psychiatry Psychiatr Epidemiol 2018; 53:617-627. [PMID: 29627898 PMCID: PMC5959987 DOI: 10.1007/s00127-018-1506-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/28/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Recent reviews have questioned the efficacy of selective serotonin reuptake inhibitors (SSRIs) above placebo response, and their working mechanisms remain unclear. New approaches to understanding the effects of SSRIs are necessary to enhance their efficacy. The aim of this study was to explore the possibilities of using cross-sectional network analysis to increase our understanding of symptom connectivity before and after SSRI treatment. METHODS In two randomized controlled trials (total N = 178), we estimated Gaussian graphical models among 20 symptoms of the Beck Depression Inventory-II before and after 8 weeks of treatment with the SSRI paroxetine. Networks were compared on connectivity, community structure, predictability (proportion explained variance), and strength centrality (i.e., connectedness to other symptoms in the network). RESULTS Symptom severity for all individual BDI-II symptoms significantly decreased over 8 weeks of SSRI treatment, whereas interconnectivity and predictability of the symptoms significantly increased. At baseline, three communities were detected; five communities were detected at week 8. CONCLUSIONS Findings suggest the effects of SSRIs can be studied using the network approach. The increased connectivity, predictability, and communities at week 8 may be explained by the decrease in depressive symptoms rather than specific effects of SSRIs. Future studies with larger samples and placebo controls are needed to offer insight into the effects of SSRIs. TRIAL REGISTRATION The trials described in this manuscript were funded by the NIMH. Pennsylvania/Vanderbilt study: 5 R10 MH55877 ( https://projectreporter.nih.gov/project_info_description.cfm?aid=6186633&icde=28344168&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC&MMOpt= ). Washington study: R01 MH55502 ( https://projectreporter.nih.gov/project_info_description.cfm?aid=2034618&icde=28344217&ddparam=&ddvalue=&ddsub=&cr=5&csb=default&cs=ASC ).
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Affiliation(s)
- Fionneke M. Bos
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands ,Department of Psychology, University of Pennsylvania, Philadelphia, PA USA
| | - Eiko I. Fried
- Department Quantitative Psychology and Individual Differences, University of Leuven, Leuven, Belgium ,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN USA
| | - Laura F. Bringmann
- Department Quantitative Psychology and Individual Differences, University of Leuven, Leuven, Belgium
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO USA
| | - Robert J. DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA USA
| | - Claudi L. H. Bockting
- Department of Psychiatry, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Bos FM, Snippe E, de Vos S, Hartmann JA, Simons CJ, van der Krieke L, de Jonge P, Wichers M. Can We Jump from Cross-Sectional to Dynamic Interpretations of Networks? Implications for the Network Perspective in Psychiatry. Psychother Psychosom 2017; 86:175-177. [PMID: 28490028 PMCID: PMC5516409 DOI: 10.1159/000453583] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Fionneke M. Bos
- University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands,University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands,*Fionneke M. Bos, MSc, University of Groningen, University Medical Center Groningen, Rob Giel Research Center, PO Box 30.001, NL-9700 RB Groningen (The Netherlands), E-Mail
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Stijn de Vos
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Jessica A. Hartmann
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands,Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Claudia J.P. Simons
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands,GGzE, Institute of Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Lian van der Krieke
- University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands,University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands,Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
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Bos FM, Schoevers RA, aan het Rot M. Experience sampling and ecological momentary assessment studies in psychopharmacology: A systematic review. Eur Neuropsychopharmacol 2015; 25:1853-64. [PMID: 26336868 DOI: 10.1016/j.euroneuro.2015.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 12/15/2022]
Abstract
Experience sampling methods (ESM) and ecological momentary assessment (EMA) offer insight into daily life experiences, including symptoms of mental disorders. The application of ESM/EMA in psychopharmacology can be a valuable addition to more traditional measures such as retrospective self-report questionnaires because they may help reveal the impact of psychotropic medication on patients' actual experiences. In this paper we systematically review the existing literature on the use of ESM/EMA in psychopharmacology research. To this end, we searched the PsycInfo and Medline databases for all available ESM/EMA studies on the use of psychotropic medication in patients with DSM-III-R and DSM-IV disorders. Dissertations were excluded. We included 18 studies that applied ESM/EMA to study the effects of medication on patients with major depressive disorder, substance use disorder, attention-deficit hyperactivity disorder, psychotic disorder, and anxiety disorder. We found that ESM/EMA may allow researchers and clinicians to track patients during different phases of treatment: before treatment to predict outcome, during treatment to examine the effects of treatment on symptoms and different aspects of daily life experience, and after treatment to detect vulnerability for relapse. Moreover, ESM/EMA can potentially help determine how long and in what contexts medications are effective. Thus, ESM/EMA may benefit both researchers and clinicians and might prove to be an effective tool for improving the treatment of psychiatric patients.
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Affiliation(s)
- Fionneke M Bos
- Department of Psychology, University of Groningen, Groningen, The Netherlands.
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Marije aan het Rot
- Department of Psychology, University of Groningen, Groningen, The Netherlands; School of Behavioral and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
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Duits N, Bos FM. [Psychiatric disorders with use of simvastatin]. Ned Tijdschr Geneeskd 1993; 137:1312-5. [PMID: 8345888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Three patients are described with serious psychiatric complications related to use of simvastatin. The psychiatric symptoms concerned were mainly depression, anxiety and suicidal tendencies but also psychotic symptoms. The hypothesis is developed that in a particular population psychiatric (mood) disorders may be triggered by use of simvastatin or other cholesterol lowering compounds. A low or lowered cholesterol level may be related to disturbances in the cerebral serotonin metabolism. It may be necessary to be more alert for psychiatric (mood) disorders when a cholesterol lowering treatment (with simvastatin) is started and to stop it when psychiatric symptoms develop, or grow worse.
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Affiliation(s)
- N Duits
- Psychiatrisch Centrum Amsterdam Zuid/Nieuw-West
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