A Mobile App to Manage Children Dental Anxiety: Context and Approach

Anxiety and fear related to dentistry interventions have been identified as problems affecting children. This reduces their quality of life and may have a negative impact on aspects such as sleep, self –esteem, mood, social relationships, and other psychological issues.The ARCADE project aims to design and develop a technological solution to manage children dental anxiety. This solution consists on a mobile system co-designed with children. An ecological momentary intervention is proposed using this solution before, during and after dentistry treatments. This paper presents a methodological approach to develop the project

Increasing Undergraduate Student Engagement in Academics: An Ecological Momentary Intervention

As students enter the university environment, they are presented with various commitments that may or may not impede academic performance. With the issues of student attrition and retention, there is a need to provide further tools for students to use to monitor their performance. As students’ progress to higher level coursework, expectations and time commitments increase, and self-regulation of learning becomes even more important. Researchers may be able to deliver information to help students with self-regulation of learning by leveraging new affordances in technology in students’ daily lives. The purpose of this dissertation was to examine the feasibility and associated findings of an ecological momentary intervention surrounding self-regulation, motivation and study strategy utilization. This quasi-experimental study had 49 participants. The overarching project for this dissertation was a two-week intensive longitudinal design with a baseline appointment. For the in the moment assessment via a smartphone application, there were two conditions: an intervention and an assessment-only group. This dissertation includes two manuscripts. The first manuscript examines methodological issues related to the feasibility of using multiple types of prompting (user-initiated and researcher-generated) when utilizing in the moment data collection in an educational context, specifically factors that may influence participants’ response rates and compliance to the researcher protocol. The second manuscript examines motivational and emotional differences of the same participants within a self-regulation intervention delivered in the moment via ecological momentary intervention. Specifically, I investigated motivational and emotional factors related to student behavior (as measured by reports of studying) during the monitoring time period. In the feasibility paper, I found overall that participants responded to approximately two prompts a day and that baseline factors such as lower self-control were associated with greater missing data. I also found discrepancies between responses to in-the-same-moment study related questions (i.e., participants saying they had not studied while also reporting a subsequent amount of time spent studying), which informed which outcomes to use in the content-based manuscript. In the content manuscript, I found no condition differences between the intervention and assessment-only groups in regard to the number of user-initiated study sessions, indicating a lack of compliance to the intervention protocol. I found that academic motivation and anxiety over time were associated with the probability of reporting studying. Finally, I found moderate relationships for end of day reports of study times with the in the moment reports, suggesting a potential rounding bias. Based upon the results, it appears there were issues with fidelity of implementation within the protocol. This could be due to the burden placed upon participants for in the moment data collection, or additional circumstances not measured within the study. In regard to lower response rates, participant compensation could have played a role due to the data collection burden. With the majority of data collection taking place during the latter part of the semester, the time of the study may have contributed to lower instances of studying as participants for various reasons (e.g., fewer assessments, already established study practices).There needs to be further refinement to the intervention protocol to be able to measure studying in the moment including direct reminders to participants about their study behaviors and ways to further develop the training protocol for initiating prompts. Additionally, waves of data collection across the course of the semester will be explored in future work

Evaluating The Effectiveness Of An Ecological Momentary Intervention Targeting Body Checking Behaviors

This study investigated the efficacy of an ecological momentary intervention (EMI) targeting body checking behaviors (weighing, mirror checking, and feeling the body for fat). Body checking has been shown to increase body dissatisfaction and play a role in eating disorders. A digitally based intervention delivered in individuals\u27 naturalistic environments has not yet been explored in the literature. Therefore, the purpose of this study was to combine ecological momentary assessment (EMA) to capture body checking frequency and an EMI to target body checking. For the current study, 44 female undergraduates with high body checking levels and healthy weight participated in a five-day intervention where they received five messages via their smart phones each day assessing the frequency of body checking. On the final two days of the study, an intervention message was also sent containing cognitive-behavioral strategies for decreasing body checking. Multilevel modeling was used to investigate the relationship between time (within day and across days), body dissatisfaction, and reported body checking. Body checking behaviors increased within each day while decreasing across the five day intervention period. Additionally, analyses of pre to posttest measures found healthy improvements in a number of body image related constructs. These results suggest that targeting body checking behaviors through a brief ecological momentary intervention may be a useful clinical tool

Comparison of Two Ecological Momentary Intervention Modules for Treatment of Depression on Momentary Positive and Negative Affect

Background: Ecological Momentary Assessment (EMA), comprising repeated self-assessments in daily life, have shown promise as an intervention strategy for depression. Whether the content of such assessments influences affect has hardly received attention. The current study consists of two EMA intervention (EMI) modules, enabling us to compare the impact of EMI content on the course of momentary affect during the intervention. Methods: The intervention, implemented as add-on to regular depression treatment, consists of intensive self-monitoring (5x/day, 28 days) and weekly personalized feedback. Patients with depressive complaints (N = 110; M-age = 32.9, SD = 12.2; 44.5% male) were randomly assigned to one of two treatment modules focusing on activities and positive affect ("Do") or on thoughts and negative affect ("Think"). Results: Linear mixed models showed no significant (p > .18) differences between the two modules on both positive and negative affect over time. Across modules positive affect showed an initial decreasing trend, leveling off towards the end of the intervention period. Negative affect did not change significantly over time (p > .06). Limitations: Both modules assessed positive and negative affect, enabling a direct comparison but potentially decreasing the impact of their differential focus. Conclusions: In our sample, the focus of the EMI was not associated with differential effects on momentary affect. This implies that a focus on thoughts and negative affect compared to positive affect and activities may not lead to added adverse effects on mood, which is an often-voiced concern when using EMA in both research and clinical practice

Transdiagnostic Ecological Momentary Intervention for Improving Self-Esteem in Youth Exposed to Childhood Adversity:The SELFIE Randomized Clinical Trial

Importance: Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorders. Ecological momentary interventions (EMIs) allow for the delivery of youth-friendly, adaptive interventions for improving self-esteem, but robust trial-based evidence is pending.Objective: To examine the efficacy of SELFIE, a novel transdiagnostic, blended EMI for improving self-esteem plus care as usual (CAU) compared with CAU only.Design, Setting, and Participants: This was a 2-arm, parallel-group, assessor-blinded, randomized clinical trial conducted from December 2018 to December 2022. The study took place at Dutch secondary mental health services and within the general population and included youth (aged 12-26 years) with low self-esteem (Rosenberg Self-Esteem Scale [RSES] <26) exposed to childhood adversity.Interventions: A novel blended EMI (3 face-to-face sessions, email contacts, app-based, adaptive EMI) plus CAU or CAU only.Main Outcomes and Measures: The primary outcome was RSES self-esteem at postintervention and 6-month follow-up. Secondary outcomes included positive and negative self-esteem, schematic self-beliefs, momentary self-esteem and affect, general psychopathology, quality of life, observer-rated symptoms, and functioning.Results: A total of 174 participants (mean [SD] age, 20.7 [3.1] years; 154 female [89%]) were included in the intention-to-treat sample, who were primarily exposed to childhood emotional abuse or neglect, verbal or indirect bullying, and/or parental conflict. At postintervention, 153 participants (87.9%) and, at follow-up, 140 participants (80.5%), provided primary outcome data. RSES self-esteem was, on average, higher in the experimental condition (blended EMI + CAU) than in the control condition (CAU) across both postintervention and follow-up as a primary outcome (B = 2.32; 95% CI, 1.14-3.50; P < .001; Cohen d-type effect size [hereafter, Cohen d] = 0.54). Small to moderate effect sizes were observed suggestive of beneficial effects on positive (B = 3.85; 95% CI, 1.83-5.88; P < .001; Cohen d = 0.53) and negative (B = −3.78; 95% CI, −6.59 to −0.98; P = .008; Cohen d = −0.38) self-esteem, positive (B = 1.58; 95% CI, 0.41-2.75; P = .008; Cohen d = 0.38) and negative (B = −1.71; 95% CI, −2.93 to −0.48; P = .006; Cohen d = −0.39) schematic self-beliefs, momentary self-esteem (B = 0.29; 95% CI, 0.01-0.57; P = .04; Cohen d = 0.24), momentary positive affect (B = 0.23; 95% CI, 0.01-0.45; P = .04; Cohen d = 0.20), momentary negative affect (B = −0.33; 95% CI, −0.59 to −0.03, P = .01, Cohen d = −0.27), general psychopathology (B = −17.62; 95% CI, −33.03 to −2.21; P = .03; Cohen d = −0.34), and quality of life (B = 1.16; 95% CI, 0.18-2.13; P = .02; Cohen d = 0.33) across postintervention and follow-up. No beneficial effects on symptoms and functioning were observed.Conclusions and Relevance: A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes. Further work should focus on implementing this novel EMI in routine public mental health provision.Trial Registration Dutch Trial Register Identifier: NL7129(NTR7475

Patients' experience of an ecological momentary intervention involving self-monitoring and personalized feedback for depression

Experts in clinical mental health research count on personalized approaches based on self-monitoring and self-management to improve treatment efficacy in psychiatry. Among other things, researchers expect that Ecological Momentary Interventions (EMI) based on self-monitoring and personalized feedback will reduce depressive symptoms. Clinical trial findings have, however, been conflicting. A recent trial (ZELF-i) investigated whether depression treatment might be enhanced by an add-on EMI with self-monitoring items and feedback focused on positive affect and activities (Do-module) or on negative affect and thinking patterns (Think-module). There was no statistical evidence that this EMI impacted clinical or functional outcomes beyond the effects of regular care, regardless of module content. In apparent contrast, 86% of the participants who completed the intervention indicated they would recommend it to others. In the present study, we used in-depth interviews (n = 20) to better understand the EMI's personal and clinical benefits and downsides. A thematic analysis of the interviews generated six areas of impact with various subthemes. In line with the trial results, few participants reported behavioral changes or symptom improvement over time; the self-assessments mainly amplified momentary mood, in either direction. The most often mentioned benefits were an increase in self-awareness, insight, and self-management (e.g., a stronger sense of control over complaints). Consistently, these domains received the highest ratings in our evaluation questionnaire (n = 89). Furthermore, the EMI instilled a routine into the days of individuals without regular jobs or other activities. Participants reported few downsides. The experiences were rather similar between the two modules. This study suggests that EMI might contribute to health by helping individuals deal with their symptoms, rather than reducing them. Measures on self-awareness, insight, and self-management should be more emphatically involved in future EMI research

Goal-Directed Self-Monitoring as an Ecological Momentary Intervention for Disordered Eating Thoughts and Behaviors

Ph.D

An evaluation of the efficacy of two add-on ecological momentary intervention modules for depression in a pragmatic randomized controlled trial (ZELF-i)

BACKGROUND: Depression treatment might be enhanced by ecological momentary interventions (EMI) based on self-monitoring and person-specific feedback. This study is the first to examine the efficacy of two different EMI modules for depression in routine clinical practice.METHODS: Outpatients starting depression treatment at secondary mental health services (N = 161; MIDS-DEPRESSION = 35.9, s.d. = 10.7; MAGE = 32.8, s.d. = 12.1; 46% male) participated in a pragmatic randomized controlled trial with three arms. Two experimental groups engaged in 28 days of systematic self-monitoring (5 times per day), and received weekly feedback on either positive affect and activities (Do-module) or negative affect and thinking patterns (Think-module). The control group received no additional intervention. Participants completed questionnaires on depressive symptoms (primary outcome), social functioning, and empowerment before and after the intervention period, and at four measurements during a 6-month follow-up period.RESULTS: Of the 90 (out of 110) participants who completed the intervention, 86% would recommend it. However, the experimental groups did not show significantly more or faster changes over time than the control group in terms of depressive symptoms, social functioning, and empowerment. Furthermore, the trajectories of the two EMI modules were very similar.CONCLUSIONS: We did not find statistical evidence that this type of EMI augments the efficacy of regular depression treatment, regardless of module content. We cannot rule out that EMIs have a positive impact on other domains or provide a more efficient way of delivering care. Nonetheless, EMI's promise of effectiveness has not materialized yet.</p

Ecological Momentary Intervention [EMI]: Incorporating Mobile Technology into a Disordered Eating Treatment Program for College Women

Psychosocial and health behavior treatments can be extended beyond research and clinical settings by using mobile technology to provide Ecological Momentary Interventions [EMI] to individuals as they go about their daily lives. This study integrates the assessment (i.e., Ecological Momentary Assessment; EMA) and intervention (i.e., EMI) capacities of palmtop computers to provide individually tailored EMI to participants in real time. The feasibility and efficacy of using EMI to augment a disordered eating treatment intervention for college women was evaluated. Participants were randomized to view psychoeducational videos on a computer (attention control), complete an interactive CD-ROM-based intervention aimed at reducing body dissatisfaction and disordered eating behaviors (CD), or receive the CD-ROM supplemented with EMI (CD+EMI). The content and timing of EMI was individually tailored in real time and provided on palmtop computers for one week following the CD intervention. Very high compliance rates with the EMA/EMI protocol were demonstrated and women were generally satisfied with the intervention, suggesting it is feasible to implement tailored EMI. An evaluation of treatment efficacy revealed the computerized CD-ROM intervention did not reliably produce significant improvements in body-related constructs and there was no unique or added benefit of EMI. This study was innovative in that it used palmtop computers to combine ambulatory assessment and intervention strategies to provide tailored and contextually sensitive EMI. As such, it adds to the relatively young, but growing EMI literature by identifying challenges and opportunities for ambulatory assessment and intervention methods in psychosocial and health behavior treatments