Search Results (164)

Background: Adolescence is marked by heightened reward sensitivity and incomplete maturation of cognitive control, creating conditions that favor engagement in risky behaviors. Traditional self-report methods often overlook the fast, automatic processes—such as attentional biases, approach–avoidance tendencies, and associative schemas—that shape adolescent decision-making in real time. Aims: This Perspective aims to synthesize recent (2018–2025) advances in the study of implicit measures relevant to adolescent risk behaviors, evaluate their predictive value beyond explicit measures, and identify translational pathways for prevention and early intervention. Methods: A narrative synthesis was conducted, integrating evidence from eye-tracking, drift-diffusion modeling, approach–avoidance tasks, single-category implicit association tests, ecological momentary assessment (EMA), and passive digital phenotyping. Emphasis was placed on multi-method phenotyping pipelines and on studies validating these tools in adolescent populations. Results: Implicit indices demonstrated incremental predictive validity for risky behaviors such as substance use, hazardous driving, and problematic digital engagement, outperforming self-reports in detecting context-dependent and state-specific risk patterns. Integrative protocols combining laboratory-based measures with EMA and passive sensing captured the influence of peer presence, affective state, and opportunity structures on decision-making. Mobile-based interventions, including approach bias modification and attention bias training, proved feasible, scalable, and sensitive to change in implicit outcomes. Acoustic biomarkers further enhanced low-burden state monitoring. Conclusions: Implicit measures provide a mechanistic, intervention-sensitive complement to explicit screening, enabling targeted, context-aware prevention strategies in adolescents. Future priorities include multi-site validations, school-based implementation trials, and the use of implicit parameter change as a primary endpoint in prevention research. Full article

Introduction/Objective: Dental extractions are among the most common oral surgical procedures worldwide, with postoperative pain representing a significant clinical concern. Cannabidiol (CBD), a non-intoxicating phytocannabinoid with analgesic and anti-inflammatory properties, has recently gained attention as a potential adjunct for managing acute dental pain. To explore its clinical utility to generate preliminary feasibility, we conducted the Simple Tooth Extraction with Analgesic Phytocannabinoid (SWAP) pilot trial to evaluate the preliminary efficacy and safety of oral CBD at two concentrations (17 mg/mL and 37 mg/mL) compared with placebo and standard ibuprofen/acetaminophen therapy following simple extractions. Materials and Methods: Eight adults were randomized equally to four arms (n = 2 per arm) CBD 17 mg/mL, CBD 37 mg/mL, placebo, or treatment-as-usual (TAU; ibuprofen/acetaminophen). CBD/placebo groups received 0.5 mL every 4–6 h as needed for 7 days, while TAU followed the non-opioid regimen. The primary endpoint was pain intensity (0–10 Numeric Rating Scale) captured via ecological momentary assessment (EMA) over 72 h. Secondary endpoints included worst pain, rescue medication use, adherence, tolerability, and qualitative feedback. Results: All participants completed follow-up with >75% EMA adherence. Because of the very small sample (n = 8), results are descriptive only. Baseline imbalance was observed; the CBD 17 mg/mL group reported substantially lower pre-extraction pain than other groups, limiting interpretability. Pain trajectories diverged by group: CBD 37 mg/mL showed the lowest ratings, paralleling TAU; CBD 17 mg/mL and placebo showed limited efficacy. Conclusions: This pilot suggests that higher-concentration CBD (37 mg/mL) may provide analgesia comparable to standard non-opioid therapy. Within this small feasibility cohort, higher-concentration CBD (37 mg/mL) appeared to produce pain patterns qualitatively similar to standard non-opioid therapy. Findings should be interpreted as exploratory only. A fully powered randomized trial incorporating biomarker endpoints and a taste-matched placebo is warranted. Full article

This study examines whether daily heat exposure worsens psychological well-being among self-employed motorcycle delivery workers in Brasília, Brazil. Using ecological momentary assessment over 15 consecutive days in August 2025, 45 workers were recruited and 30 (66.7%) completed twice-daily mobile prompts (12:00 and 18:00) rating stress, fatigue, mood, and perceived heat (1–5 scales) and reporting kilometers traveled. Environmental data (temperature, relative humidity, barometric pressure) were paired from the INMET Brasília station. Linear regressions with cluster-robust standard errors by participant tested associations. Higher temperature was consistently related to greater strain: each +1 °C was associated with higher stress (β = 0.196, 95% CI 0.179–0.213), higher fatigue (β = 0.289, 95% CI 0.284–0.295), and worse mood (β = 0.149, 95% CI 0.130–0.168). Adding relative humidity yielded small but reliable partial effects (lower stress and better mood, yet higher fatigue) amid strong dry-season collinearity between temperature and humidity. The findings indicate that even modest day-to-day warming corresponds to measurable deterioration in psychological outcomes in a precarious, outdoor, platform-mediated workforce. Policies that expand hydration and shaded rest access, integrate heat indices into alerts, and adapt platform scheduling to reduce peak-heat exposure may mitigate risk. Full article

Background: Obesity is a complex health issue influenced by various factors, including behavioral patterns that can be assessed more deeply in real time using Ecological Momentary Assessment (EMA), which can capture the moment in which a person experiences a situation or an emotion that could trigger an eating behavior. Methods: This systematic review synthesizes findings from 89 studies employing EMA to investigate obesity and overweight-related behaviors. The studies were identified through comprehensive searches across multiple databases and included peer-reviewed articles. The primary aim was to analyze how EMA contributes to understanding the temporal dynamics of eating behaviors, physical activity, and psychological factors associated with overweight and obesity. Results: Key findings indicate that EMA provides a nuanced understanding of real-time contexts influencing behaviors contributing to overweight and obesity. Studies consistently report that EMA captures fluctuations in eating habits, exercise routines, stress levels, and emotional states, elucidating the interplay between these factors and weight status. Methodological variations across studies included differences in EMA implementation (e.g., smartphone apps, electronic diaries), assessment frequency, and duration. These variances highlight the flexibility and adaptability of EMA in capturing diverse behavioral aspects relevant to obesity and overweight research. Moreover, the review discusses methodological challenges such as participant compliance, data integration, and real-time data interpretation in longitudinal analyses. Conclusions: In conclusion, EMA emerges as a powerful tool for exploring the complex, dynamic nature of overweight and obesity-related behaviors. Future research should focus on refining EMA methodologies, enhancing data analysis techniques, and integrating findings into personalized interventions aimed at reducing obesity effectively. Full article

Background/Objectives: Major depressive disorder (MDD) is often characterized by mood instability and occupational imbalance, leading to impaired functioning and reduced quality of life. Despite increasing recognition of occupational therapy’s (OT’s) role in mental health, few interventions comprehensively describe both their development process and their theoretical rationale. This article aims to present the systematic development of the mood–occupation balance reciprocal model (MOBILE) intervention for people with MDD, guided by the Medical Research Council (MRC) framework for complex intervention. Methods: Development followed three phases: (1) identifying the evidence base, (2) developing theory, and (3) modeling processes and outcomes. Theoretical foundations integrated occupation- and mood/function-based models with client-centered, lived-experience perspectives. A preliminary ecological momentary assessment (EMA) study on mood and daily function interplay further informed the intervention development. Input from focus groups with occupational therapists and individuals with lived experiences supported its iterative refinement. Following MRC guidelines, a small pilot study (N = 2) was conducted with inpatients diagnosed with MDD to assess the feasibility and acceptability of the intervention and EMA procedures. The pilot evaluated recruitment, adherence, engagement, and practicality of delivery within a clinical setting. Results: The pilot study, although it included only two inpatients and thus limits generalizability, demonstrated high adherence, engagement, and feasibility. The EMA protocol was well tolerated, leading to minor refinements that enhanced its clinical applicability. Stakeholders emphasized the program’s relevance, adaptability, and the value of personalized planning tools. Conclusions: The MOBILE intervention is delivered as an individualized program to enhance mood stability and daily functioning among inpatients with MDD. It provides a theoretically grounded, context-sensitive framework integrating personalized goal setting and strategy use with the construction of a balanced routine. Implications: This article provides a comprehensive account of development procedures to support future evaluation, implementation, and integration into OT mental health practice. Full article

Background/Objectives: This study evaluated whether personalized nutrition (PN) advice combined with disclosure of genetic information leads to a greater reduction in caffeine consumption than PN advice alone in slow caffeine metabolizers in the short and long terms. Additionally, Ecological Momentary Assessment (EMA) was considered for its potential to improve dietary intake assessment. Methods: In 2019–2021, 94 adults (aged 18–60 years, C allele carriers of rs762551 CYP1A2, consuming ≥ 200 mg/day caffeine), 63% of whom were women, participated in a twenty-week intervention. Participants were randomized to receive PN with genotype information (the intervention group, n = 55) or without it (the control group, n = 39). All participants were advised to limit caffeine intake to 100 mg/day. Caffeine intake was assessed using a food frequency questionnaire and a smartphones application. After three years caffeine intake was reassessed. Results: After the intervention, caffeine consumption decreased (intervention group: 380.69 ± 217.58 to 153.73 ± 98.19 mg/day; control group: 394.44 ± 256.29 to 169.87 ± 85.70 mg/day; p < 0.01), with no group differences (p = 0.41). Three years later, a reduction (p < 0.01) was still observed in the intervention group, but the effect of time x group was insignificant. In total, 63% of the intervention group and 51% of the control group responded to at least three EMA prompts per day for at least three days. Conclusions: PN seems to affect caffeine intake in the long term. However, including genotype information in PN is no more effective than receiving PN recommendations without genetic information. EMA’s effectiveness in large-scale nutritional research may be limited due to the relatively low response rate. Full article

Background: The acquisition of adaptive skills is critical for independence and participation in activities of daily living (ADL). While caregiver perceptions provide valuable insights, most studies on autistic participation have focused on older children and relied on one-time clinic-based assessments. As a result, little is known about how autistic toddlers function in their natural environments across time. Ecological momentary assessment (EMA) is a real-time, context-sensitive method in which parents can report behaviors at multiple time points in the child’s natural environment. This pilot study aimed to examine ADL independence in autistic toddlers compared to their typically developing (TD) peers, to assess the feasibility of using EMA in early childhood, and to compare EMA-based assessments with a one-time standardized report. Methods: 23 autistic toddlers and 28 TD toddlers (aged 18–40 months) participated in the study. Parents completed a one-time report on the self-care scales of the Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure for Children (WeeFIM) and then rated their child’s independence on the WeeFIM twice a day for two weeks via their smartphones. Results: EMA was feasible with high response rates (ASD: 91.1%, TD: 88.55%). Autistic toddlers showed different participation profiles, with less independent performance in ADL compared to TD peers. In the autism group, the average EMA scores (M = 16.53, SD = 6.58) were significantly higher than the one-time WeeFIM scores (M = 13.74, SD = 5.23), t (22) = 3.23, p < 0.01, suggesting underreporting in single-time assessments. In contrast, no such difference was found in the TD group. Significant positive correlations were found between the EMA mean and the one-time WeeFIM scores in both groups (r > 0.80), indicating convergent validity. In the autism group only, greater variability in EMA was moderately associated with higher functional independence (r = 0.46, p < 0.01). Conclusions: These findings indicate that autistic toddlers demonstrated higher levels of participation in their natural environment than reflected by the one-time assessment, emphasizing the limitations of single-time-point evaluations. This underscores the importance of collecting data across multiple time points to accurately assess adaptive functioning and ADL participation. The EMA technique demonstrated in this study provides exploratory evidence of feasibility as an ecologically valid approach to assessing functional independence in autistic toddlers, offering a richer and more context-sensitive alternative to traditional one-time clinical assessments. Full article

Diagnosis and monitoring of daytime sleepiness remain challenging and are strongly reliant on subjective assessments. To revisit common monitoring tools and explore new assessment modalities, we investigated the response of daily and momentary subjective measures of sleepiness and fatigue and skin temperature to sleep restriction, assessed between- and within-day variations in these responses, and studied their convergence. Seventeen healthy participants (aged 19–32 years, seven females, ten males) participated in a field study employing ecological momentary assessment. After a one-week baseline, two sleep conditions (4 h/night vs. 7–9 h/night, actigraphy-controlled; three nights each) were counterbalanced across participants. During the experimental conditions, sleepiness and fatigue were assessed using subjective rating scales administered in daily diary questionnaires and experience sampling questionnaires (10 notifications per day), while distal and proximal skin temperatures were continuously recorded. Results revealed significant effects of sleep restriction on distal and proximal skin temperature and daily reports of sleepiness and fatigue, independent of the number of sleep-restricted nights. The effects on momentary assessments were moderated by day, reflecting a cumulative effect of the sleep restriction from Days 1 to 3. The effects of sleep restriction on momentary sleepiness and fatigue ratings or hourly skin temperature metrics were not significantly moderated by time of day. Hourly skin temperatures (distal skin temperature and temperature gradient) were significantly related to subjective sleepiness and fatigue. In conclusion, all self-reports were sensitive to the sleep restriction, but momentary assessments illustrate the manipulation’s cumulative effects and captured temporal dynamics in sleepiness and fatigue within days. This investigation showed overlap between sleepiness and fatigue experiences as reflected in medium to strong associations. Skin temperature correlates with momentary subjective sleepiness (and fatigue); however, considering it a proxy for daytime sleepiness remains exploratory. Full article

Understanding what aspects of daily life protect against loneliness is increasingly important for promoting well-being among older adults. This study investigates how different types of everyday social interactions are associated with chronic loneliness. We analyze data that were collected via in-home surveys and an ecological momentary assessment module from a probability-based sample of 272 adults aged 55 and older residing in Indiana. Participants were prompted four times per day over the course of seven days to report on their current activities and social experiences. Contrary to common assumptions, the quantitative measures of daily social interactions, such as the proportion of moments spent alone, the proportion of moments spent socializing, and the mean number of interaction partners during the study period were not significantly related to loneliness. However, the qualitative measures of social interactions—specifically, the presence of bonding social capital (e.g., emotional closeness) and the absence of stressful interactions—were associated with lower levels of loneliness. These findings underscore the importance of emotionally meaningful engagement and social strain over the sheer frequency or quantity of interactions, suggesting that the quality of daily social experiences is a key factor in supporting mental well-being in later life. Full article

Background/Objectives: Many cancer survivors continue to experience persistent symptoms such as pain, fatigue, and depression. Exercise and increasing physical activity (PA) are recommended as methods that can help alleviate these symptoms. However, maintaining regular exercise can be difficult due to the challenge of maintaining motivation. This secondary analysis uses data from a randomized controlled pilot study that examines the feasibility of the technology-enhanced combined exercise and other nonpharmacological interventions, such as the TEHEplus program, in managing symptoms. The program used mobile technologies and sent weekly physical performance reports to maintain engagement. In this study, we aimed to examine the impact of weekly physical performance reports on daily symptoms and PA and explored characteristics as moderators. Methods: This secondary analysis included participants who completed the 12-week TEHEplus program. Daily data of steps (PA), sleep duration, and symptoms (rated on a 4-point scale) were collected for 84 days. Mixed-effects and lagged regression models were used to assess the impact of weekly physical performance reports and the moderating effects of baseline characteristics. Results: Seventy-seven survivors of solid tumor cancer (mean age, 59.79, SD = 12.17) were analyzed. During this 84-day period, participants reported a reduction in low energy (B = −0.003, p = 0.004). Step counts increased by an average of 141 steps immediately after each weekly report (B = 140.857, p = 0.027). An increase of 5000 steps on the prior day was related to decreasing pain (B = −0.047, p < 0.001) and fatigue/low energy (B = −0.082, p < 0.001). Two additional hours of prior-night sleep worsened pain (B = 0.029, p = 0.001) and fatigue/low energy (B = 0.027, p = 0.002). Gender, employment, race, caregiver, and type of treatments moderate the relationship between daily PA, sleep (B = −0.131~0.078, p_s < 0.05). Conclusions: Weekly physical performance reports promoted PA, which possibly led to self-reported improvement of symptoms. Higher PA was associated with better self-report symptoms, but longer sleep duration was associated with worsened symptoms, suggesting the need for future studies. The moderating effects suggested that tailoring interventions to individual profiles may enhance the program’s effectiveness. Full article

Using individualized approaches leads to longer-term pro-health behavior change. Both technological delivery methods and values-centered Acceptance and Commitment Therapy (ACT) are useful frameworks for personalized interventions. This investigation sought to explore the effects that valuing had on health using an internet-delivered audio and writing group-level intervention. Specifically, we replicated the use of domain-specific outcomes and idiographic motivational statements sent via text message while additionally employing individualized intervention delivery components, objectives, and statistical methods. While this intervention did not generate significant improvement in health behaviors relative to a control in a sample of 107 college student participants, it has implications for future digital health intervention design and implementation as well as the further development of theoretically consistent valuing research methods. Full article

Awake Bruxism (AB) is defined as masticatory muscle activity during wakefulness, characterized by repetitive or sustained tooth contact and/or the bracing or thrusting of the mandible. AB remains less understood than Sleep Bruxism (SB), and its identification remains a methodological challenge. The aim of this study was to introduce the Awake Bruxism Identification Tool (ABIT), developed for children and adolescents aged 8 to 12 years, to facilitate the identification of AB. The tool integrates data from self-reports, clinical examinations, and the Ecological Momentary Assessment (EMA). It comprises questionnaires using a five-point Likert scale, an analog EMA component involving color-based responses, and a clinical inspection. The tool adopts the concept of an “AB Spectrum”, as it generates individualized scores based on the combined outcomes of these multiple assessment components. The ABIT was piloted with ten families to evaluate its comprehensibility, applicability, and reliability. The results demonstrated that the participants found the questions understandable, that the tool had a minimal impact on daily family routines, and that it required approximately 5–10 min to complete. Additionally, the test–retest reliability indicated temporal stability. In terms of identification, four children were classified within the “AB identified by report and self-report,” while three were identified through the “report, self-report, and EMA.” Based on participant feedback, adjustments were made to the instrument, including the addition of an item addressing Sleep Bruxism. Although the ABIT is being applied for the first time in a research setting, it presents a promising, clinically relevant approach grounded in the self-perception of children and their caregivers. Full article

Digital biomarkers for fatigue monitoring in neurological disorders represent an innovative approach to bridge the gap between mechanistic understanding and clinical application. This perspective paper examines how smartphone-derived measures, analyzed through artificial intelligence methods, can transform fatigue assessment from subjective, episodic reporting to continuous, objective monitoring. The proposed framework for smartphone-based digital phenotyping captures passive data (movement patterns, device interactions, and sleep metrics) and active assessments (ecological momentary assessments, cognitive tests, and voice analysis). These digital biomarkers can be validated through a multimodal approach connecting them to neuroimaging markers, clinical assessments, performance measures, and patient-reported experiences. Building on the previous research on frontal–striatal metabolism in multiple sclerosis and Long-COVID-19 patients, digital biomarkers could enable early warning systems for fatigue episodes, objective treatment response monitoring, and personalized fatigue management strategies. Implementation considerations include privacy protection, equity concerns, and regulatory pathways. By integrating smartphone-derived digital biomarkers with AI analysis approaches, the future envisions fatigue in neurological disorders no longer as an invisible, subjective experience but rather as a quantifiable, treatable phenomenon with established neural correlates and effective interventions. This transformative approach has significant potential to enhance both clinical care and the research for millions affected by disabling fatigue symptoms. Full article

Background: Borderline Personality Disorder (BPD) is a debilitating mental health condition characterized by emotional dysregulation and interpersonal dysfunction, with perceived social rejection exacerbating these issues. Emerging evidence suggests that a single session of transcranial direct current stimulation (tDCS) over the right ventrolateral prefrontal cortex (rVLPFC) may decrease the unique tendency of BPD patients to feel rejected even when socially included during a laboratory task. Objectives: This protocol outlines a double-blind, sham-controlled study evaluating the longitudinal effects of repeated anodal tDCS over the right ventrolateral prefrontal cortex (rVLPFC) on rejection-related emotions (RRE) during real-life social interactions in individuals with BPD. Methods: Sixty BPD patients will be randomized to receive real or sham tDCS across 10 daily sessions, coupled with an ecological momentary assessment (EMA) protocol capturing emotional and behavioral responses to real-life social interactions over four timepoints: baseline, during treatment, ten days post-treatment, and three months post-treatment. Primary outcomes include changes in RRE, with exploratory analyses examining feelings of social connection, aggressive tendencies, trust toward others, and interpersonal and affective dynamics. Multilevel modeling will assess temporal and group-level effects. Expected Results and Impact: This study aims to establish the efficacy of tDCS in reducing BPD patients’ negative emotional response in real-life social situations and to determine whether such effects are maintained in time. The findings could advance the clinical application of tDCS as an adjunctive intervention to alleviate social–emotional impairments in BPD, addressing gaps in current treatment approaches and guiding future research into the neural mechanisms of social emotion regulation. Full article

Background: Musculoskeletal problems contribute to nurse attrition, which compromises patient safety and costs healthcare organizations millions of dollars. Recent research describes a physical activity paradox in which high amounts of work-related physical activity may be detrimental to health; however, there is a lack of evidence on the physical activity paradox with respect to musculoskeletal health in nurses. The purpose of this study was to examine the relationship between musculoskeletal symptoms (MSSs) and high amounts of physical activity at work in nurses. Methods: This was a 7-day observational design using direct measurement of physical activity and self-reported MSSs in nurses. Physical activity was measured in step counts using a wearable accelerometer and MSSs were reported using ecological momentary assessment. Step counts and MSSs were compared between work days and days off, and a regression model analyzed the combined effect of physical activity and work days on MSSs while controlling for age, exercise, and body mass index. Results: Musculoskeletal symptoms and step counts were significantly higher on work days compared to days off. Higher step counts on work days resulted in significantly higher expected MSS ratings than the same number of steps taken on a day off. Conclusions: This study supports the existence of a physical activity paradox in nurses with respect to MSSs. Understanding this paradox in the nursing workforce can translate to interventions that reduce the detrimental health effects of high levels of physical activity at work, which can minimize nurse attrition, improve patient outcomes, and reduce costs in healthcare organizations. Full article