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Ecological momentary assessment (EMA) is increasingly recognized as a vital tool for tracking the fluctuating nature of mental states and symptoms in psychiatric research. However, determining the optimal sampling rate - that is, deciding how often participants should be queried to report their symptoms - remains a significant challenge. To address this issue, our study utilizes the Nyquist-Shannon theorem from signal processing, which establishes that any sampling rate more than twice the highest frequency component of a signal is adequate. We applied the Nyquist-Shannon theorem to analyze two EMA datasets on depressive symptoms, encompassing a combined total of 35,452 data points collected over periods ranging from 30 to 90 days per individual. Our analysis of both datasets suggests that the most effective sampling strategy involves measurements at least every other week. We find that measurements at higher frequencies provide valuable and consistent information across both datasets, with significant peaks at weekly and daily intervals. Ideal frequency for measurements remains largely consistent, regardless of the specific symptoms used to estimate depression severity. For conditions in which abrupt or transient symptom dynamics are expected, such as during treatment, more frequent data collection is recommended. However, for regular monitoring, weekly assessments of depressive symptoms may be sufficient. We discuss the implications of our findings for EMA study optimization, address our study's limitations, and outline directions for future research.

Background/Hypothesis Digital interventions targeting transdiagnostic mechanisms in daily life may be a promising translational strategy for prevention and early intervention of psychotic and other severe mental disorders. We aimed to investigate the feasibility and initial signals of efficacy of a transdiagnostic, compassion-focused, hybrid ecological momentary intervention for improving resilience (ie, EMIcompass) in youth with early mental health problems. Study Design In an exploratory, assessor-blind randomized controlled trial, youth aged 14–25 with current distress, broad at-risk mental state, or first episode of severe mental disorder were randomly allocated to experimental (EMIcompass+treatment as usual [TAU]) or control condition (TAU). Data on primary (stress reactivity) and secondary candidate mechanisms as well as candidate primary (psychological distress) and secondary outcomes were collected. Study Results Criteria for the feasibility of trial methodology and intervention delivery were met (n = 92 randomized participants). No serious adverse events were observed. Initial outcome signals were evident for reduced momentary stress reactivity (stress×time×condition, B = −0.10 95%CI −0.16–−0.03, d = −0.10), aberrant salience (condition, B = −0.38, 95%CI −0.57–−0.18, d = −0.56) as well as enhanced momentary resilience (condition, B = 0.55, 95%CI 0.18–0.92, d = 0.33) and quality of life (condition, B = 0.82, 95%CI 0.10–1.55, d = 0.60) across post-intervention and 4-week follow-up. No outcome signals were observed for self-reported psychological distress (condition, B = 0.57, 95%CI −1.59–2.72, d = 0.09), but there was suggestive evidence of reduced observer-rated symptoms at the 4-week follow-up (B = −1.41, 95%CI −2.85–0.02, d = −0.41). Conclusions Our findings provide evidence of feasibility and initial signals that EMIcompass may reduce stress reactivity and improve quality of life. A definitive trial is now warranted.

Social anxiety lies on a continuum, and young adults with elevated symptoms are at risk for developing a range of psychiatric disorders. Yet relatively little is known about the factors that govern the hour-by-hour experience and expression of social anxiety in the real world. Here we used smartphone-based ecological momentary assessment (EMA) to intensively sample emotional experience across different social contexts in the daily lives of 228 young adults selectively recruited to represent a broad spectrum of social anxiety symptoms. Leveraging data from over 11 000 real-world assessments, our results highlight the central role of close friends, family members, and romantic partners. The presence of such close companions was associated with enhanced mood, yet socially anxious individuals had fewer confidants and spent less time with the close companions that they do have. Although higher levels of social anxiety were associated with a general worsening of mood, socially anxious individuals appear to derive larger benefits - lower levels of negative affect, anxiety, and depression - from their close companions. In contrast, variation in social anxiety was unrelated to the amount of time spent with strangers, co-workers, and acquaintances; and we uncovered no evidence of emotional hypersensitivity to these less-familiar individuals. These findings provide a framework for understanding the deleterious consequences of social anxiety in emerging adulthood and set the stage for developing improved intervention strategies.

Prospective memory, the ability to remember an intention at the appropriate future moment, is often investigated in the laboratory to maximize experimental control. However, demands of laboratory prospective memory tasks only partly map onto everyday demands. Therefore, it is an open question whether factors which predict prospective memory in the laboratory also predict prospective memory in the real world. We combined diary and ecological momentary assessment methods to investigate which factors, that have been repeatedly shown to predict prospective memory performance in laboratory tasks, are related to the fulfillment of everyday intentions. Results showed that substantial portions of variance in real-world prospective memory performance could be explained with the factors found to be significant in laboratory. The most powerful predictors were perceived intention importance, the use of external memory aids, delay interval, and conscientiousness. However, some meaningful laboratory predictors (e.g., working memory) played only a minor role in natural environments and a large portion of the variance in everyday intention fulfillment remained unexplained. The results substantially extend the understanding of conditions and personality variables most conducive to remembering intentions, but they also suggest that additional factors influencing real-world prospective memory remain to be discovered.

Background While chronic workplace stress is known to be associated with health-related outcomes like mental and cardiovascular diseases, research about day-to-day occupational stress is limited. This systematic review includes studies assessing stress exposures as work environment risk factors and stress outcomes, measured via self-perceived questionnaires and physiological stress detection. These measures needed to be assessed repeatedly or continuously via Ecological Momentary Assessment (EMA) or similar methods carried out in real-world work environments, to be included in this review. The objective was to identify work environment risk factors causing day-to-day stress. Methods The search strategies were applied in seven databases resulting in 11833 records after deduplication, of which 41 studies were included in a qualitative synthesis. Associations were evaluated by correlational analyses. Results The most commonly measured work environment risk factor was work intensity, while stress was most often framed as an affective response. Measures from these two dimensions were also most frequently correlated with each other and most of their correlation coefficients were statistically significant, making work intensity a major risk factor for day-to-day workplace stress. Conclusions This review reveals a diversity in methodological approaches in data collection and data analysis. More studies combining self-perceived stress exposures and outcomes with physiological measures are warranted.

Background Major depressive disorder (MDD) is a highly prevalent mental disorder with large disease burden, high levels of relapse or persistence, and overall suboptimal outcomes of protocolized pharmacological and psychotherapeutic treatments. There is an urgent need to improve treatment effectiveness, possibly through systematic treatment personalization. In psychotherapeutic treatments this can be achieved by case conceptualization. To support this process, we developed the Therap-i module, which consists of personalized Experienced Sampling Methodology (ESM) and feedback. The Therap-i module is integrated into outpatient psychotherapeutic treatment as usual (TAU) for depression. The study aim is to investigate the efficacy of the Therap-i module in decreasing symptomatology in unresponsive or relapsing patients diagnosed with MDD. We hypothesize that the Therap-i module will contribute to TAU by i) decreasing depressive symptoms, and ii) improving general functioning, therapeutic working alliance, and illness perception. This paper provides details of the study rationale, aims, procedures, and a discussion on potential pitfalls and promises of the module. Methods Patients diagnosed with MDD ( n  = 100) will enrol in a pragmatic two-armed randomized controlled trial. Randomization is stratified according to the patient’s treatment resistance level assessed with the Dutch Method for quantification of Treatment Resistance in Depression (DM-TRD). All fill-out the Inventory of Depressive Symptomatology Self Report (IDS-SR), Outcome Questionnaire (OQ-45), Illness Perception Questionnaire Mental Health (IPQ-MH), and Work Alliance Inventory Self Report (WAI-SR). In the intervention arm, through close collaboration between patient, clinician, and researcher, a personalized ESM diary is developed based on the patient’s case conceptualization. During the ESM monitoring period (8 weeks, 5 assessments/day), patients receive feedback three times, which is discussed among the abovementioned three parties. Both patients and clinicians will evaluate the Therap-i module. Results Data collection is ongoing. Discussion This is the first study in which personalized ESM and feedback is integrated in outpatient psychotherapeutic TAU for depression. The labour intensive procedure and methodological pitfalls are anticipated challenges and were taken into account when designing the study. When hypotheses are confirmed, the Therap-i module may advance treatment for depression by providing insights into personalized patterns driving or perpetuating depressive complaints. Trial registration Trial NL7190 (NTR7381) , registered prospectively 03-08-2018.

Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient's long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate. The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool. A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants' attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes. We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers. All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales.

Nicotine and cannabis vaping are common among young adults and can potentially lead to adverse health consequences. Identifying real-time antecedents of vaping events may provide insights into intervention targets pertinent to these behaviors. This study aimed to examine real-time antecedents of nicotine and cannabis vaping and same-occasion co-vaping among young adults. This study aims to examine real-time antecedents of nicotine and cannabis vaping and same-occasion co-vaping among young adults. We collected ecological momentary assessments (EMAs) via a smartphone app among California young adults (ages 18-29 y) in 2023-2024. Participants completed four random prompts each day for 30 consecutive days. Outcomes were defined as whether participants reported being about to vape nicotine, cannabis, or both substances (same-occasion co-vaping) in a given EMA. We used mixed-effects logistic regression models to examine real-time antecedents of each outcome. Overall, 113 participants (mean age 23.8 y, SD3 y, 63% female, n=70) completed 9001 EMAs. Similar antecedents of all 3 vaping outcomes were craving and using alcohol. Increased cravings for a given substance were associated with a higher likelihood of vaping that substance or co-vaping. Craving for cannabis vaping was associated with lower odds of reporting nicotine vaping (adjusted odds ratio [AOR] 0.87, 95% CI 0.82-0.92). Feeling happier was associated with higher odds of reporting co-vaping (AOR 1.13, 95% CI 1.01-1.27) while feeling more stressed was associated with lower odds of vaping nicotine (AOR 0.95, 95% CI 0.91-0.98) or cannabis (AOR 0.91, 95% CI 0.86-0.97). Seeing tobacco advertisements was associated with higher odds of vaping nicotine (AOR 3.09, 95% CI 1.48-6.46) and co-vaping (AOR 4.15, 95% CI 1.18-14.52). Cannabis vaping was more likely to occur in the afternoon (AOR 1.52, 95% CI 1.16-1.98) and nighttime (AOR 1.95, 95% CI 1.45-2.63) than in the morning. Co-vaping was also more likely to occur in the afternoon (AOR 1.59, 95% CI 1.14-2.22) and nighttime (AOR 1.84, 95% CI 1.26-2.71) than in the morning, but the association was not held for nicotine vaping. Nicotine vaping was more likely to occur on weekends compared to weekdays (AOR 1.25, 95% CI 1.09-1.45), but no significant associations were found for cannabis vaping and co-vaping. We found similar antecedents (craving and alcohol use) and unique antecedents (mood, advertising exposure, and time of day) for nicotine vaping, cannabis vaping, and same-occasion co-vaping, suggesting targets for future vaping cessation interventions.

Background To design effective tailored interventions to promote physical activity (PA) among older adults, insights are needed into the contexts in which older adults engage in PA and their affective and physical experiences. Sensor-triggered event-based ecological momentary assessment (EMA) is an innovative method for capturing real-life contexts, as well as affective and physical states, during or immediately after specific events, such as PA. This study aimed to (1) describe the physical and social contexts, and the affective and physical states during PA among older adults, (2) evaluate how these constructs fluctuate during PA episodes, and (3) describe affective states during PA according to the context. Methods An intensive longitudinal sensor-triggered event-based EMA study was conducted with 92 Belgian older adults (65 + years). During seven days, participants were monitored using a Fitbit, which triggered a smartphone-based questionnaire on the event-based EMA platform ‘HealthReact’ after a five-minute walk. Participants reported on contexts and affective (positive/negative valence) and physical states (pain and fatigue) during the PA event. Descriptive statistics and generalized mixed models were used for data analysis. Results Older adults predominantly engaged in daily physical activities, such as walking for transport, leisure walking, and gardening, rather than structured exercise. They consistently reported high positive affect, low negative affect, and minimal physical complaints during PA. Furthermore, older adults mainly engage in physical activities alone, particularly in outdoor settings. Variations in contexts, affect, and fatigue were mostly driven by within-subject differences. The model showed significant differences across times of day, with negative affect being highest in the evening and fatigue lowest in the morning. Additionally, the physical and social context influenced negative affect (but not positive affect), with outdoor activities performed alone and indoor activities performed with others being associated with lower negative affect. Conclusions While these findings could enhance the effectiveness of tailored PA interventions, it remains unclear whether the observed affective and physical states are causes or effects of PA, and whether the contexts in which the activities were performed align with older adults’ preferences. Further research is needed to explore these relationships and to better understand older adults’ preferred PA contexts.

Background and Hypotheses Affective recovery, operationalized as the time needed for affect to return to baseline levels after daily stressors, may be a putative momentary representation of resilience. This study aimed to investigate affective recovery in positive and negative affect across subclinical and clinical stages of psychosis and whether this is associated with exposure to childhood trauma (sexual, physical, and emotional abuse). Study Design We used survival analysis to predict the time-to-recovery from a daily event-related stressor in a pooled sample of 3 previously conducted experience sampling studies including 113 individuals with first-episode psychosis, 162 at-risk individuals, and 94 controls. Study Results Negative affective recovery (ie, return to baseline following an increase in negative affect) was longer in individuals with first-episode psychosis compared with controls (hazard ratio [HR] = 1.71, 95% confidence interval [CI; 1.03, 2.61], P = .04) and in at-risk individuals exposed to high vs low levels of emotional abuse (HR = 1.31, 95% CI [1.06, 1.62], P = .01). Positive affective recovery (ie, return to baseline following a decrease in positive affect) did not differ between groups and was not associated with childhood trauma. Conclusions Our results give first indications that negative affective recovery may be a putative momentary representation of resilience across stages of psychosis and may be amplified in at-risk individuals with prior experiences of emotional abuse. Understanding how affective recovery contributes to the development of psychosis may help identify new targets for prevention and intervention to buffer risk or foster resilience in daily life.