Agenda. Innovative, valid, reproducible and feasible methods for integrated assessment of determinants and behaviours. I.

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1 Innovative, valid, reproducible and feasible methods for integrated assessment of determinants and behaviours Ulrich Ebner-Priemer Agenda Relevant for - the assessment of PA and diet - the assessment of determinants - Intervention The method: Ambulatory Assessment I. Real-time Definition The use of computer-assisted methodology to assess self-reports, behaviors and physiological processes, while the participant undergoes normal daily activities. Related terms - Ambulatory Monitoring - Ecological Momentary Assessment - Experience Sampling Method Key features real-time, real-life, objective, within-subject processes, intervention Trull & Ebner-Priemer, 2014, Ann. Rev. Clin. Psych.

2 I. real-time memory 14. Mai 13. Mai 12. Mai 11. Mai 10. Mai 9. Mai 8. Mai 7. Mai 6. Mai 5. Mai 4. Mai 3. Mai 2. Mai 1. Mai 30. April 29. April 8.12 h 7.36 h 7.12 h 7.55 h 6. 48h 5.36 h 8.02 h 7.45 h 7.36 h 7.26 h 7.12 h 6.34 h 6.35 h 8.02 h 8.16 h 7.34 h 28. April 27. April 26. April 25. April 24. April 23. April 22. April 21. April 20. April 19. April 18. April 17. April 16. April 15. April 6.23 h 8.04 h 7.36 h 8.01 h 7.15 h 6.58 h 6.43 h 5.56 h 8.34 h 7.23 h 7.34 h 7.35 h 7.07 h 7.28 h = h / 30 Tage = 7.05h/Tag Gathering information retrospectively is problematic as retrospective ratings are subject to multiple systematic distortions - Affective valence effect (Kihlstrom, 2000) - Mood congruent memory effect (Kihlstrom, 2000) - Peak end rule & duration neglect (Kahneman et al., 1993) - Digit bias (Shiffman & Paty, 2005) Ebner-Priemer & Trull, Psych. Ass., 2009 systematic distortion II. Real life questionaire diary objective Sloths (Faultier; Bradypus variegatus) sleep in captivity 15.85h, but in tropical rainforest 9.63 Silvia et al., 2007; n=2113 Sleeping outside the box, Biology, 2008

3 Agenda Within-subject processes / mechanisms classical parameters in studying determinants of PA Age Gender Marital status General physical health Belief in importance of physical activity Emotional distress Advice of physician about getting more exercise Self-mastery Koenemann et al., 2011 Time course of physical activity and mood Time course of physical activity and mood Running feel uncomfortable & short of breath overweight sweating ridiculous & ashamed proud, relieved, positively tired out -The psychological consequences and determinants of physical activity change over time -To understand the (positive an negative) (short) term consequences/determinants of physical activity, it is necessary to assess them over time.

4 Within-subject processes / mechanisms Within-subject processes / mechanism night - Continuous monitoring and online analyses of physical activity night - Episodes of activity or inactivity are identified online and trigger a beep which alarms participants to fill out an ediary activity (15 min. moving average) activity (15 min. moving average) Ebner-Priemer et al., 2013, Frontiers in Psychology Ebner-Priemer et al., 2013, Frontiers in Psychology Within-subject processes / mechanism In clinical psychology within-subject processes like stress reactivity or reward experience show added value in predicting treatment success (Geschwind et al., 2011; Wichers et al., 2012), relapse (Leemput et al., 2014, Wichers et al., 2010). Agenda Two approaches 1) to increase awareness 2) to intervene in critical situations

5 Interventions to increase awareness interventions to increase awareness 102 subjects under treatment for depressive symptoms randomized E diary feedback TAU + e diary + feedback E diary assessment TAU + e diary Control group TAU Post ESM HDRS IDS => Feedback on the within-subject relation between social interaction and mood Follow ups ESM HDRS IDS PA per type of activity active relaxation passive relaxation doing nothing/resting work/study talking self care eating/drinking on the way household not at all much PA Kramer et al., 2014 Kramer et al, 2014 Results interventions (in real time): the idea control group e-diary assessment e-diary feedback Behavior is triggered in the moment (real-time) by cues like the location (bar) or social partner (friends) etc. Ambulatory assessment with real time intervention can detect high risk situations and offer support when help is needed. => Real-time feedback of determinants of own behavior improved psychopathological symptoms Gustafson et al., 2014, JAMA Psychiatry

6 interventions (in real time) interventions (in real time) Continuing care for alcohol disorders is associated with better outcomes, but rarely done. 349 patients with alcohol dependency were randomized when entering residential treatment to a) treatment as usual (n = 179) or b) TAU plus smartphone APP (n = 170) as continuing care Smartphone APP Static content - audio-guided relaxation Interactive features - If a patient neared a high-risk location (a bar she used too frequent), GPS initiated an alert asking the patient if she wanted to be there. - Counselors received patient updates on protective and risky items related to drinking (such as lifestyle balance, quality of sleep, negative affect, and recent substance use). Gustafson et al., 2014, JAMA Psychiatry Gustafson et al., 2014, JAMA Psychiatry interventions (in real time) Results The APP group showed - fewer risky drinking days (the primary outcome) - greater abstinence than control patients. Upcoming developments - Smartphone: multiple sensors (e-diary, GPS, phone-calls, SMS, activity, etc.) processor power - Real-time analyses => GPS-triggered e-diary => activity-triggered e-diary => physiology triggered e-diary => Real-time intervention worked. - long-term monitoring (18 months) - (empirically supported) real-time interventions Gustafson et al., 2024, JAMA Psychiatry

7 downsides / problems?? downsides / problems?? Reactivity - difficult to investigate - no difference for 3 / 6 / 12 assessments per day (Stone et al., 2003) - high compliance (> 90%) - Reactivity for specific symptoms (intrusions) - number of items is limited - timely resolution is limited - total assessment period is limited - battery power is limited -.. Generalizability - Studies with old participants (age > 80) - Studies with difficult patients Summary Empirical support that Thanks