Search Results (95)

Ecological momentary assessment (EMA) captures real-time data on thoughts, emotions, and behaviours within individuals’ natural environments. Although EMA has been increasingly used to examine self-harm, existing reviews have not focused specifically on adolescents. This systematic review examines EMA research on adolescent self-harm, focusing on methodological considerations and key risk and protective factors for self-harm. Five databases, plus pre-print, unpublished and grey literature sources, were searched up to 30 January 2024. Studies were included if published in English, used EMA methodology, included adolescents aged 10–24 years and measured suicidal ideation, suicidal behaviours, or self-harm. The review included 79 studies, published from 2009 to the present. Self-harm was associated with numerous risk factors, including negative affect, stress, interpersonal influences and sleep. EMA was generally well-accepted by adolescent participants, with high compliance rates. The findings highlight the value of EMA in capturing real-time fluctuations in self-harm and associated risk factors among adolescents. EMA demonstrates strong potential for improving understanding and prediction of self-harm; yet challenges remain, including variability in study designs and a lack of clear reporting of the methodologies. Future research should focus on standardising methodologies, increasing participant diversity, and exploring the clinical utility of EMA in early intervention and prevention strategies. Full article

Background/Objectives: Psychological stress is a common problem but hard to universally treat. Personalized (N-of-1) trials assess a participant’s response to multiple specific interventions. Though personalized (N-of-1) trials have been used in select interventions, no prior research has examined whether N-of-1 designs provide superior stress reduction relative to standard of care. Methods: Participants were randomized to personalized N-of-1 (N = 106) or standard-of-care (N = 106) arms for three stress-management interventions (mindfulness meditation; yoga; brisk walking). All participants completed ecological momentary assessments (EMA) of stress three times daily for 18 weeks (2-week baseline, 12-week intervention, 2-week assessment, and 2-week follow-up). After the intervention, participants in the N-of-1 arms received a personalized report identifying which intervention worked best for them. All participants chose one intervention to manage their stress during follow-up. The primary outcome was change in perceived stress between baseline and follow-up. Results: Participants in the personalized (N-of-1) arms did not report significantly reduced EMA stress levels relative to standard-of-care (p = 0.496), though the effect was stronger among N-of-1 participants who chose the stress-management intervention recommended by their report [B(SE) = −0.67(0.34); p = 0.049]. Conclusions: Results show the potential of personalized (N-of-1) trials to provide individuals with information unique to them to help identify interventions for stress management. However, many participants in the personalized trial arms did not choose the intervention recommended by their trial. Additional research is required to refine how personalized (N-of-1) trials are conducted and how trial results are reported to participants to ensure the maximal benefit of these trial designs. Full article

Background/Objectives: Ecological momentary assessment (EMA) is a methodology that offers a real-time approach to monitoring clinician well-being, but its utility during high-intensity operational periods remains underexplored. This study examines the feasibility and performance of an EMA-based system for tracking clinical responsibilities and burnout among healthcare workers during the first year of the COVID-19 pandemic. Methods: Utilizing an intensive longitudinal design, 398 healthcare workers, including physicians, physician assistants, nurses, and trainees, completed brief EMA surveys every five days from April 2020 to March 2021. Burnout was assessed with a validated single-item measure and analyzed in relation to redeployment status and hospital caseloads. Results: The EMA approach successfully captured meaningful temporal fluctuations in burnout. Redeployment was associated with higher burnout levels (b = 0.125; p = 0.01), and rising caseloads amplified this effect (interaction b = 0.169; p = 0.001). Nurses showed the strongest caseload-related increases in burnout (b = 0.359; p < 0.001). These patterns persisted even after individuals returned to their usual roles. Conclusions: This study demonstrates that EMA is a scalable and sensitive approach for continuous burnout surveillance, capable of detecting role-specific and context-dependent stress responses in real time. EMA-based monitoring can support early identification of at-risk groups, guide staffing and redeployment decisions, and inform timely organizational interventions during crises and other periods of operational strain. Full article

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

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

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

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

Tinnitus is defined as the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes tinnitus disorder when the phantom sound is associated with suffering and/or disability. There is only limited knowledge about the time course of tinnitus disorder. Bereavement science has identified four different trajectories: resilience, recovery, chronic, and delayed. The question arises whether these four trajectories exist in tinnitus as well if one considers tinnitus as the loss of silence (at will). To verify whether these four trajectories exist, short-term tinnitus progression was analyzed retrospectively using an Ecological Momentary Assessment (EMA) approach, extracting the data from patients who started using the TrackYourTinnitus (TYT) app (version 1, Ulm University, 2013) from the start of their tinnitus perception. Four patients were identified retrospectively via the TYT app with acute tinnitus, and the bereavement trajectories were reconstructed based on EMA. In conclusion, this perspective suggests that the four known bereavement trajectories may exist in tinnitus, and prospective evaluations of larger samples are warranted to confirm or disprove this analogy between bereavement and tinnitus, in which tinnitus is conceived as the loss of (controllable) silence. Full article

Background/Objectives: Over 5 million youth under the age of 19 provide daily, hands-on care to an ill or injured family member across the United States. Yet how these young carers perceive the care they deliver in the moment, and how these perceptions relate to well-being, is unexplored, particularly in complex neurological conditions. This paper presents initial data on young carers for a family member with amyotrophic lateral sclerosis (ALS). Methods: Ecological momentary assessment (EMA) was used to measure perceptions of care in the moments of care and the cognitive and emotional states of the young carers during those moments. Young carers (n = 15) aged 10–19 were followed for seven days, completing assessments three times per day, which provided 260 total measurements. Young carers reported frequently engaging in caregiving (~39% of assessments). Results: The results indicated that it was not simply performing a caregiving task that related to outcomes, but rather how caregiving moments were perceived that mattered. Caregiving moments perceived as more fulfilling resulted in young carers feeling less discontent and more focused, whereas caregiving moments perceived as lacking resources predicted more discontent and distress. Exploratory analyses highlighted the potential for burden for young carers. They reported high levels of worry when they were not around the care recipient, with this worry predicting feeling more discontent and distressed. Conclusions: Young carers are deeply involved in care and perceive care differently across moments, both positive and negative. These initial data can be used to develop targeting support programs in the moment of care, potentially lessening the negative impacts of care. Full article

Physical activity (PA) is essential for healthy aging, but its accurate assessment in older adults remains challenging due to the limitations and biases of traditional clinical assessment. Mobile technologies and wearable sensors offer a more ecological, less biased alternative for evaluating PA in this population. This study aimed to optimize digital phenotyping strategies for assessing PA patterns in older adults, by integrating ecological momentary assessment (EMA) and continuous wearable sensor data collection. Over two weeks, 108 community-dwelling older adults provided real-time EMA responses while their PA was continuously monitored using Garmin Vivo 5 sensors. The combined approach proved feasible, with 67.2% adherence to EMA prompts, consistent across time points (morning: 68.1%; evening: 65.4%). PA predominantly occurred at low (51.4%) and moderate (46.2%) intensities, with midday activity peaks. Motivation and self-efficacy were significantly associated with low-intensity PA (R = 0.20 and 0.14 respectively), particularly in the morning. However, discrepancies between objective step counts and self-reported PA measures, which showed no correlation (R = −0.026, p = 0.65), highlight the complementary value of subjective and objective data sources. These findings support integrating EMA, wearable sensors, and temporal frameworks to enhance PA assessment, offering precise insights for personalized, time-sensitive interventions to promote PA. Full article

Background/Objectives: Excess adiposity, affecting 43% of the global adult population, is a major contributor to cardiometabolic diseases. Lifestyle behaviours, specifically dietary habits, play a key role in weight management. Real-time assessment methods such as Ecological Momentary Assessment (EMA) provide context-rich data that reduce recall bias and offer insights into dietary triggers and lapses. This study examines dietary triggers among adults with excess adiposity in Singapore using EMA, focusing on factors influencing dietary adherence and lapses. Methods: A total of 250 participants with a BMI ≥ 23 kg/m² were recruited to track dietary habits for one week, at least three times a day, using the Eating Behaviour Lapse Inventory Survey Singapore (eBLISS) embedded within the Eating Trigger Response Inhibition Program (eTRIP© V.1) smartphone app. Logistic regression analysis was used to identify predictors of dietary adherence. Results: Of the 4708 responses, 76.4% of the responses were indicative of adherence to dietary plans. Non-adherence was primarily associated with food accessibility and negative emotions (stress, nervousness, and sadness). Factors such as meals prepared by domestic helpers and self-preparation were significantly associated with adherence. Negative emotions and premenstrual syndrome were identified as significant predictors of dietary lapses. Conclusions: EMA offers valuable insights into dietary behaviours by identifying real-time triggers for dietary lapses. Future interventions can utilise technology-driven approaches to predict and prevent lapses, potentially improving adherence and weight management outcomes. Full article