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AbstractFirearm availability is correlated with increased risk of suicide but its link with suicidal ideation remains unclear. Previous studies are limited by retrospective reports and prospective designs with lengthy gaps between assessments that are ill-suited for measuring fluctuations in suicidal ideation. This study used ecological momentary assessment (EMA) to repeatedly assess suicidal ideation in a sample of 138 U.S. adults (81 handgun owners, 57 non-owners). Participants received six EMA prompts per day for 28 consecutive days. Results revealed no group differences in the frequency, maximum amplitude, or variability of suicidal ideation across male and female handgun owners and non-owners. Stability of suicidal ideation significantly differed across groups, however (F(1,132) = 4.5, p = 0.036); male handgun owners had the strongest stability and male non-owners had the weakest stability. Stability of suicidal ideation was significantly lower when participants reported a firearm was nearby as compared to when no firearm was nearby (F(4,17732) = 5.6, p < 0.001). Results suggest firearm availability increases reactivity to the environment, slows recovery from acutely elevated risk states, and may increase vulnerability to sudden shifts to higher risk states characterized by increased probability of suicidal behavior. Although these effects were observed in both handgun owners and non-owners, they disproportionately impact handgun owners because they report being near firearms more often. [ABSTRACT FROM AUTHOR]

Acute stressors (e.g., time pressure) can provoke psychological and physiological stress responses, and the magnitude of such responses is called stress reactivity. However, stress reactivity levels can differ considerably among individuals, with exaggerated levels being associated with adverse outcomes (e.g., emotional exhaustion). Previous studies have primarily investigated psychological stress reactivity or physiological stress reactivity induced in the laboratory. Physiological stress reactivity, especially concerning heart rate variability (HRV), has rarely been examined so far in real life. We addressed this research gap in a sample of 394 adults who participated in 2- to 4-day ecological momentary assessments. Individuals answered self-reports on perceived time pressure and emotional exhaustion multiple times a day and simultaneously wore electrocardiogram sensors. Based on 4,009 total situations and 3–16 situations per participant, individual differences in HRV reactivity to time pressure were computed as random slopes from multilevel models. Consistent with preregistered hypotheses, increased time pressure was associated with reduced HRV, and increased stress reactivity was associated with increased emotional exhaustion. The findings highlight the detrimental effects of everyday demands and physiological reactivity and emphasize the relevance of practical coping strategies. This study contributes to research on dynamic inter- and intraindividual stress regulation using ambulatory, psychophysiological methods. [ABSTRACT FROM AUTHOR]

Introduction: Investigations on emotion regulation strategies (ERS) primarily focus on the influence of instructed emotion regulation (ER) on outcomes. However, recent work has shown that selection of ERS is dependent on, e.g., situational demands and personal resources. Methods: In this current investigation, we used an online diary to investigate ERS used by free choice and their association with ER-success, stress and rumination. We identified four factors of ERS: cognitive perspective change, cognitive-behavioral problem-solving, suppression-distraction and body-social ERS. Associations of ERS with stress, state-rumination and ER-success were investigated using multilevel-mixed-models, allowing to separate within- and between-subject effects. Results: Our results show that, on a within-subject level, all adaptive ERS were positively associated with ER-success, while maladaptive ERS as well as higher stress and state rumination were negatively associated with ER-success. On the other hand, only within-subject cognitive ERS were associated with higher self-efficacy. Maladaptive ERS-use was consequently positively associated with stress and state rumination. Surprisingly, only cognitive perspective change ERS were negatively associated with state rumination. Cognitive-behavioral problem-solving was positively associated with stress and success of emotion regulation. Discussion: We interpret these results in the light of situational constraints of ERS-use and the importance of the assessment of these in future studies. [ABSTRACT FROM AUTHOR]

Background: Limited research considers the quantity and potency of cannabis products along with social context on the subjective effects of real-world cannabis use. Aims: This study examined the subjective effects of acute use as a function of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) doses and social context during cannabis use episodes. Method: Ninety-six participants (43.75% male, M age = 35.73) reporting weekly cannabis use completed a baseline self-report battery assessing cannabis use. Then, THC and CBD potency and quantity of the cannabis product, social context, and subjective experience were assessed through self-initiated surveys after cannabis use episodes during a 14-day ecological momentary assessment (EMA). Results: Greater feeling high and liking were significantly associated with a higher THC dose than one's average (b = 0.03, p < 0.001; b = 0.02, p < 0.001) and social use (b = 0.38, p < 0.001; b = 0.20, p = 0.01). A higher CBD dose than one's average (b = 0.01, p = 0.04) was significantly associated with greater liking. A significant interaction effect of THC dose and social context (b = 0.01, p = 0.02) was observed such that solitary use had a negative association between THC dose and disliking (b = −0.01, p = 0.04), and social use had a null association (b = 0.003, p = 0.25). Individuals with greater cannabis problems reported lower liking (b = −0.18, p = 0.03) and higher disliking (b = 0.08, p = 0.02), but not feeling high, on average, across the EMA protocol. Conclusion: Social context plays an important role in the subjective experience of cannabis use. Interventions targeting cannabis problems could highlight the evidence that individuals with greater cannabis problems might experience less liking but more disliking in general across use episodes to effectively challenge expectancies/motives of use. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesign and study sampleResultsConclusionsThe aim of this study was to use Ecological Momentary Assessment (EMA) to capture how stigma-induced identity threat is experienced by adults with hearing loss and how they respond to such threats in daily life.Twenty adults with hearing loss from 53 to 88 years (mean age of 69.4 years) completed a range of demographic and stigma questionnaires in the laboratory and, over a two-week period, answered daily EMA surveys.A total of 633 EMA surveys were collected. Five participants reported 13 listening events in which they experienced stigma. These events were typically when conversing with family or friends who were aware of the adults’ hearing loss.The number of individual stigma experiences captured by EMA were low, when viewed across a large number of social interactions. However, as a group, a quarter of the participants in this study experienced stigma over a two-week period, typically from others close to them. This suggests that stigma experiences may be a regular occurrence for some adults with hearing loss. [ABSTRACT FROM AUTHOR]

Hyperarousal is a key symptom of anxiety, stress-related disorders, and insomnia. However, it has been conceptualized in many different ways, ranging from various physiological markers (e.g. cortisol levels, high-frequency EEG activity) to personality traits, or state assessments of subjective anxiety and tension. This approach resulted in partly inconsistent evidence, complicating unified interpretations. Crucially, no previous studies addressed the likely variability of hyperarousal within and across days, nor the relationship of such variability in hyperarousal with the night-by-night variability in sleep quality characteristic of insomnia. Here, we present a novel data-driven approach to understanding dynamics of state hyperarousal in insomnia. Using ecological momentary assessment, we tracked fluctuations in a wide range of emotions across 9 days in 169 people with insomnia disorders and 38 controls without sleep problems. Exploratory factor analysis identified a hyperarousal factor, comprised of items describing tension and distress. People with insomnia scored significantly higher on this factor than controls at all timepoints. In both groups, the hyperarousal factor score peaked in the morning and waned throughout the day, pointing to a potential contributing role of sleep or other circadian processes. Importantly, the overnight increase in hyperarousal was stronger in people with in insomnia than in controls. Subsequent adaptive LASSO regression analysis revealed a stronger overnight increase in hyperarousal across nights of worse subjective sleep quality. These findings demonstrate the relationship between subjective sleep quality and overnight modulations of hyperarousal. Disorders in which hyperarousal is a predominant complaint might therefore benefit from interventions focused on improving sleep quality. [ABSTRACT FROM AUTHOR]

Although survivors of childhood cancer are at an increased risk, little is known about the prevalence of chronic pain, associated interference, and daily pain experiences. Survivors (N 5 233; mean age 5 40.8 years, range 22-64 years; mean time since diagnosis 5 32.7 years) from the Childhood Cancer Survivor Study completed pain and psychosocial measures. Survivors with chronic pain completed 2-week, daily measures assessing pain and psychological symptoms using mHealth-based ecological momentary assessment. Multivariable-modified Poisson and linear regression models estimated prevalence ratio estimates (PR) and mean effects with 95% confidence intervals (CI) for associations of key risk factors with chronic pain and pain interference, respectively. Multilevel mixed models examined outcomes of daily pain and pain interference with prior day symptoms. Ninety-six survivors (41%) reported chronic pain, of whom 23 (24%) had severe interference. Chronic pain was associated with previous intravenous methotrexate treatment (PR 5 1.6, 95% CI 1.1-2.3), respiratory (PR 5 1.8, 95% CI 1.2-2.5), gastrointestinal (PR 5 1.6, 95% CI 11.0-2.3), and neurological (PR 5 1.5, 95% CI 1.0-2.1) chronic health conditions, unemployment (PR 5 1.4, 95% CI 1.0-1.9) and clinically significant depression and anxiety (PR 5 2.9, 95% CI 2.0-4.2), as well as a diagnosis of childhood Ewing sarcoma or osteosarcoma (PR 5 1.9, 95% CI 1.0-3.5). Higher pain interference was associated with cardiovascular and neurological conditions, unemployment and clinical levels of depression and/or anxiety, and fear of cancer recurrence. For male, but not female survivors, low sleep quality, elevated anxiety, and elevated depression predicted high pain intensity and interference the next day. A substantial proportion of childhood cancer survivors experience chronic pain and significant associated interference. Chronic pain should be routinely evaluated, and interventions are needed. [ABSTRACT FROM AUTHOR]

Feeling loved by one's caregiver is essential for individual flourishing (i.e., high levels of psychological well‐being in multiple dimensions). Although similar constructs are found to benefit adolescent well‐being, research that directly tests parental love as a feeling from the recipient's perspective is rare. Historically, parental love has been measured using single‐assessment methods and assumed to be a stable, trait‐like characteristic; yet, like any feeling, it may fluctuate in meaningful ways on a day‐to‐day basis—the implications of which are unknown. Using a sample of 150 adolescents (59.3% female; ages 14–16), this study estimated level (person's mean level across days) and instability (fluctuations across days) of feeling loved by a caregiver across 21 days for each adolescent, and then examined their prospective effects on adolescent flourishing 1 year later. After controlling for demographics (adolescent age, gender, family income, and parent's sex) and variable baseline levels, feeling more loved by one's caregiver in daily life significantly predicted higher levels of flourishing in two global measures 1 year later. Moreover, level and instability of feeling loved by one's caregiver played different roles for different dimensions of flourishing: higher levels significantly predicted higher levels of autonomy, purpose in life, and personal growth, whereas higher instability significantly predicted lower levels of positive relations with others and environmental mastery. Findings emphasized the importance of considering daily dynamics of feeling loved by one's caregiver and demonstrated that level (of feeling loved) is particularly important for intrapersonal aspects while instability is particularly important for interpersonal aspects of flourishing. Research Highlights: Adolescents feeling more loved by their caregiver in daily life had higher levels of overall flourishing 1 year later.Level (of feeling loved) is particularly important for intrapersonal aspects of adolescent flourishing, including autonomy, purpose in life, and personal growth.Stability (of feeling loved) is particularly important for interpersonal aspects of adolescent flourishing, including positive relations with others and environmental mastery. [ABSTRACT FROM AUTHOR]

Strategies to detect the presence of suicidal ideation (SI) or characteristics of ideation that indicate marked suicide risk are critically needed to guide interventions and improve care during care transition periods. Some studies indicate that machine learning can be applied to momentary data to improve classification of SI. This study examined whether the classification accuracy of these models varies as a function of type of training data or characteristics of ideation. A total of 257 psychiatric inpatients completed a 3-week battery of ecological momentary assessment and measures of suicide risk factors. The accuracy of machine learning models in classifying the presence, duration, or intensity of ideation was compared across models trained on baseline and/or momentary suicide risk data. Relative feature importance metrics were examined to identify the risk factors that were most important for outcome classification. Models including both baseline and momentary features outperformed models with only one feature type, providing important information in both correctly classifying and differentiating individual characteristics of SI. Models classifying SI presence, duration, and intensity performed similarly. Results of this study may not generalize beyond a high-risk, psychiatric inpatient sample, and additional work is needed to examine temporal ordering of the relationships identified. Our results support using machine learning approaches for accurate identification of SI characteristics and underscore the importance of understanding the factors that differentiate and drive different characteristics of SI. Expansion of this work can support use of these models to guide intervention strategies. • Strategies to detect suicide ideation are needed for timely intervention. • Machine learning models are relevant for accurately identifying suicide ideation. • Different risk factors are useful for classifying ideation characteristics. • Both baseline and momentary risk factor training data are essential. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) and borderline personality disorder (BPD) often co-occur, with 20 % of adults with MDD meeting criteria for BPD. While MDD is typically diagnosed by symptoms persisting for several weeks, research suggests a dynamic pattern of symptom changes occurring over shorter durations. Given the diagnostic focus on affective states in MDD and BPD, with BPD characterized by instability, we expected heightened instability of MDD symptoms among depressed adults with BPD traits. The current study examined whether BPD symptoms predicted instability in depression symptoms, measured by ecological momentary assessments (EMAs). The sample included 207 adults with MDD (76 % White, 82 % women) recruited from across the United States. At the start of the study, participants completed a battery of mental health screens including BPD severity and neuroticism. Participants completed EMAs tracking their depression symptoms three times a day over a 90-day period. Using self-report scores assessing borderline personality disorder (BPD) traits along with neuroticism scores and sociodemographic data, Bayesian and frequentist linear regression models consistently indicated that BPD severity was not associated with depression symptom change through time. Diagnostic sensitivity and specificity may be restricted by use of a self-report screening tool for capturing BPD severity. Additionally, this clinical sample of depressed adults lacks a comparison group to determine whether subclinical depressive symptoms present differently among individuals with BPD only. The unexpected findings shed light on the interplay between these disorders, emphasizing the need for further research to understand their association. • Depression symptoms were measured through ecological momentary assessments (EMAs) three times a day over a ninety-day period. • Borderline personality disorder traits were not linked to instability of overall or individual depressive symptoms across time. • Findings diverged from expectations and highlight the need for further research on the relationship between BPD and MDD. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Study Objectives Methods Results Conclusions The introduction of a smartphone‐based ecological momentary assessment (EMA) approach has allowed achieving data on the frequency of different awake bruxism (AB) behaviours (i.e., teeth contact, teeth clenching, teeth grinding, and mandible bracing) reported by an individual in the natural environment.The fluctuation of AB reports over time has a certain degree of variability that has never been investigated. Therefore, the aim of this investigation was to assess the long‐term fluctuation of AB behaviours in a population of young adults.A smartphone application was used to assess a real‐time report on five specific oral conditions related to AB in a sample of 77 young adults, aged 24.0 ± 0.8 years. Data were recorded over three periods of 7 days, with a three‐month interval for a total of 6 months.The average frequency of the relaxed condition was 72.9%, 78.2%, and 80.8% at the end of the first, second, and third sessions, respectively. On average, teeth contact and mandible bracing were the most frequently reported conditions, with a mean prevalence of 12.9% and 7%, respectively, whilst the frequency of teeth clenching and teeth grinding was less than 3%. The ANOVA test showed an absence of significant differences (p < 0.05) between the three recording periods, and the frequency was in general only moderately variable from day‐to‐day (e.g., the coefficient of variation (CV) for the condition “relaxed jaw muscles” was 0.3). No gender differences were detected either.Findings suggest that in a population of healthy individuals, the frequency of AB behaviours over a six‐month monitoring period is quite constant. This investigation represents a standpoint for future comparisons on the study of natural fluctuations of AB behaviours as well as on AB frequency in populations with risk/associated factors and possible clinical consequences. [ABSTRACT FROM AUTHOR]

Background and Aims Methods Results Conclusions Studies show that higher levels of positive affect (PA) and lower levels of negative affect (NA) are related to craving and alcohol consumption at a daily level in men, but little is known on these associations at a momentary level, and whether they are present in women. This study measured the dynamics of within‐person NA and PA surrounding craving, non‐heavy alcohol use and binge drinking in women with alcohol use disorder (AUD) and female controls without AUD.53 female patients with AUD and 75 female controls, all recruited in Belgium, were included in an experience sampling study where they reported on momentary NA, PA, craving and alcohol use in daily life over a period of 12 months. Assessments occurred eight times a day on Thursdays, Fridays and Saturdays in seven bursts of three weeks.Within‐person NA at a previous assessment (t−1) predicted craving at the current assessment (t0) in patients with AUD in a positive linear [β = 0.043; 95% confidence interval (CI) = 0.002, 0.057; P = 0.041] and quadratic fashion (β = 0.034; CI = 0.011, 0.057; P = 0.004). Within‐person PA at t−1 predicted craving at t0 in patients with AUD with a positive quadratic relation (β = 0.042; CI = 0.08, 0.065; P < 0.001). Within‐person NA at t−1 negatively predicted non‐heavy alcohol use at t0 in a linear fashion in controls (β = −0.495; CI = ‐0.677, ‐0.312; P < 0.001) and patients with AUD (β = −0.276; CI = ‐0.421, ‐0.132; P < 0.001). Within‐person PA at t−1 significantly predicted non‐heavy alcohol use at t0 with a positive linear term (β = 0.470; CI = 0.329, 0.610; P < 0.001) in controls, but with a positive linear term (β = 0.399; CI = 0.260, 0.454; P < 0.001) and a positive quadratic term (β = 0.203; CI = 0.060, 0.347; P = 0.003) in patients with AUD. Within‐person NA at t−1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (β = 0.236; CI = 0.060, 0.412; P = 0.008), but not for controls. Within‐person PA at t−1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (β = 0.378; CI = 0.215, 0.542; P < 0.001), and this was also the case for controls (β = 0.487; CI = 0.158, 0.770; P < 0.001). Non‐heavy alcohol use at t0 predicted lower levels of NA at t+1 in both patients with AUD (β = −0.161; SE = 0.044; CI = ‐0.248, 0.074; P = 0.001) and controls (β = −0.114; CI = ‐0.198, ‐0.029; P = 0.010). Non‐heavy alcohol use at t0 also predicted higher levels of PA at t+1 in both patients with AUD (β = 0.181; CI = 0.088, 0.274; P < 0.001) and controls (β = 0.189; CI = 0.101, 0.278; P < 0.001).The momentary relation between affect and craving or alcohol use seems to be non‐linear in female patients with alcohol use disorder, whereby a worse mood predicts subsequent alcohol use, though more for binge drinking than for non‐heavy alcohol use. [ABSTRACT FROM AUTHOR]

Previous studies have implied that stress is a risk factor for depression, but relatively little is known about how healthy individuals' stress dynamically affects depression as a mood in daily life. Therefore, an ecological momentary assessment study was conducted among 141 college students to test the temporal dynamic effect of daily perceived stress on depression and the underlying mediating and moderating role of rumination. Perceived stress, state rumination, and depression were measured using self‐compiled questionnaire three times a day over 12 days. Trait rumination was measured with the Nolen‐Hoeksema Ruminative Response Scale. Hierarchical linear models with HLM 7.0 were adopted to examine the mediation and moderation effects. In the mediation model, the greater the daily perceived stress at time t, the higher the state rumination at time t + 1, and state rumination at t + 1 positively predicted college students' depression at t + 2. In the moderation model, trait rumination significantly facilitated perceived stress‐induced depression. These results verified that daily perceived stress could affect college students' depression directly or indirectly through the critical mediating mechanism of state rumination, and this effect would be exacerbated with a higher level of trait rumination. [ABSTRACT FROM AUTHOR]

Objective: This study tested a highly individualized cognitive-behavioral coping skills treatment for alcohol use disorder (AUD). Recent studies have indicated that coping skills training programs are not always effective. A possible explanation is that the training provided in these programs may not address the specific needs of the patient. The Individualized Assessment and Treatment Program (IATP) was intended to provide a highly individualized approach to the training of skills most relevant for each individual. Method: Men and women with AUD (N = 173) were randomly assigned to one of three, manualized, 12-session treatments: IATP, a conventional (Packaged) cognitive-behavioral program (PCBT), or a Case Management control condition (CaseM). An experience sampling (ES) procedure was employed prior to, and during, treatment to record alcohol use and coping behaviors in all patients. In IATP, this information was used by therapists to plan treatment that would address the specific strengths and weaknesses of each patient in alcohol-use situations. ES data were collected at multiple time points and patients were followed every 3 months out to 21 months posttreatment. Results: Multilevel model analyses indicated that IATP yielded better drinking outcomes than the CaseM or PCBT conditions. Mediation analyses indicated that the effects of IATP versus the other treatments on outcomes were accounted for at least partly by changes in active coping with high-risk situations. Conclusion: Due to the limited diversity of the sample, generalizability of the results may be limited. Results are discussed in terms of the importance of tailoring treatment for the individual patient. What is the public health significance of this article?: This study indicates that a highly individualized coping skills program is an effective treatment for alcohol use disorder. Additionally, results of the study suggests that coping skills acquisition may be a mechanism of treatment for alcohol use disorder. The use of ecological momentary assessment may provide an effective means to individualize treatments for a variety of disorders. [ABSTRACT FROM AUTHOR]

According to SAMHSA (2023), approximately 16,600,000 American adults and teens reported having serious thoughts of suicide in 2022. While suicide prevention has primarily focused on suicide deaths and attempts, we contend that suicidal ideation (SI) deserves more in-depth investigation and should be an essential intervention target on its own. In support of this point, we provide three examples of ways to improve specificity in understanding of SI through the study of controllability of SI, the language used to assess SI, and measuring SI in real time. We also consider qualitative work on the content of SI, its treatment, and definitional considerations. We thus call for an increased general focus on SI within research, clinical care, and policy. [ABSTRACT FROM AUTHOR]

College counseling centers are seeing increasing rates of suicidal thoughts and behaviors, and nonsuicidal self-injury (NSSI) among students. The high degree of need and limited resources underscores the need for novel approaches to identify at-risk students. We used latent profile analysis (LPA) to identify subgroups of students (n = 371) with different patterns of interpersonal factors and examine whether these subgroups differed by risk for self-injurious thoughts and behaviors. The best-fitting LPA had three profiles, which differed in urges to die by suicide and engage in NSSI. The profile with low average social support and higher instability (greater day-to-day fluctuations of self-reported social support and rejection) was associated with greatest risk, suggesting that this combination leaves individuals more vulnerable to suicide and NSSI. [ABSTRACT FROM AUTHOR]

Creative ideation constitutes an important human skill to develop innovative solutions in science and technology and to overcome daily challenges. Although creative ideation takes place in everyday life situations, the moment-to-moment dynamics of creative ideation performance has not been intensively investigated so far. Fortunately, well-developed methods exist to assess creative ideation performance in controlled settings that can be adopted for assessments in real-life contexts. In the present field-study, a novel Ambulatory Battery of Creativity (ABC) was applied to a sample of 77 participants for 5 days. Each day, participants had to complete 12 randomly presented items of two divergent thinking tasks—half in the verbal and half in the figural domain. Psychometric analyses indicated good between-person (≥.84) and within-person (≥.70) reliability. Furthermore, between-person and within-person validity evidence of the ABC was obtained. This study constitutes a first attempt to develop a reliable and valid ABC to measure both individual differences and moment-to-moment fluctuations of creative ideation performance in everyday life. [ABSTRACT FROM AUTHOR]

Social support is a key predictor of well‐being, but not everyone experiences mental health benefits from receiving it. However, given that a growing number of interventions are based on social support, it is crucial to identify the features that make individuals more likely to benefit from social ties. Emerging evidence suggests that neural responses to positive social feedback (i.e., social reward) might relate to individual differences in social functioning, but potential mechanisms linking these neural responses to psychological outcomes are yet unclear. This study examined whether neural correlates of social reward processing, indexed by the reward positivity (RewP), relate to individuals' affective experience following self‐reported real‐world positive social support events. To this aim, 193 university students (71% females) underwent an EEG assessment during the Island Getaway task and completed a 10‐day ecological momentary assessment where participants reported their positive and negative affects (PA, NA) nine times a day and the count of daily positive and negative events. Experiencing a higher number of social support positive events was associated with higher PA. The RewP moderated this association, such that individuals with greater neural response to social feedback at baseline had a stronger positive association between social support positive events count and PA. Individual differences in the RewP to social feedback might be one indicator of the likelihood of experiencing positive affect when receiving social support. Social support is key to well‐being and, as such, it is typically implemented in various intervention programs for several mental disorders. However, not everyone benefits from social support in the same way. This study integrated laboratory and ecological momentary assessment measures to elucidate the role of neural responses to social rewards in determining whether an individual will experience positive affect when exposed to social support events. [ABSTRACT FROM AUTHOR]

Introduction: Suicidal ambivalence is increasingly understood as the result of the interplay of two conflicting motivational orientations, the wish to die (WTD) and wish to live (WTL). However, research is scarce regarding the nature of their relationship, their temporal structure, and their relevance in predicting suicidal desire. Methods: Fifty psychosomatic/psychiatric inpatients (17 reporting suicide attempts) took part in an intensive longitudinal design with 10 signal‐contingent prompts per day over 10 days; assessing WTD, WTL, and suicidal desire. We calculated mean values and variability of WTD, WTL, suicidal ambivalence, and suicidal desire and tested mixed‐effects models of suicidal desire. Results: The mean number of answered prompts was 40.98 (SD = 21.68). Repeated‐measures correlation of WTD and WTL was r = −0.60. Patients with a history of suicide attempts reported higher WTD, lower WTL, more suicidal ambivalence, stronger suicidal desire, and showed higher variability in all constructs. At the same assessment, WTD was the strongest statistical predictor of suicidal desire. Only WTL and the interaction of WTD and WTL predicted suicidal desire prospectively. Conclusion: Wish to die and WTL are likely two distinct (although correlated) constructs that should not be reduced to a single ambivalence score. A stronger focus on WTL holds potential for suicide research and practice. [ABSTRACT FROM AUTHOR]

Objective: Suicide risk is highly fluctuating. There is a need for predictors of short‐term change in suicide risk to optimize risk assessment and treatment, especially among individuals who already attempted suicide. Methods: Based on 1776 daily assessments of 16 former psychiatric inpatients with a history of suicide attempts, we examined how suicidal ambivalence and, respectively, wish to die (WTD) and wish to live (WTL) predicted same‐day and change in perceived suicide risk (i.e., next‐day perceived suicide risk, controlled for same‐day perceived suicide risk) in multilevel regression models. Additionally, based on the assumptions of nonlinear dynamics, we examined the associations between levels of fluctuations in the WTD/WTL and perceived suicide risk within the same time period. Results: Suicidal ambivalence, WTD, and a WTL significantly correlated with same‐day suicide risk. Suicidal ambivalence and WTD significantly predicted change in suicide risk. Fluctuations in WTD were significantly associated with concurrent suicide risk. Conclusion: The results suggest that suicidal ambivalence and WTD are drivers of suicide risk among individuals who already attempted suicide. The association between fluctuations in WTD and suicide risk was small and warrants further investigation on the practical utility as a warning sign. [ABSTRACT FROM AUTHOR]

Few studies have investigated how older people's daily activities and characteristics of the surrounding urban environment affect their emotions and daily satisfaction. This study fills the research gap by using a paper-based survey and a smartphone ecological momentary assessment (EMA) application (with GPS tracking and pop-up surveys about activities) to study older people's well-being in Hong Kong. Three hundred and two older adults completed the paper survey and forty-two of them further completed a six- to seven-day EMA survey. Based on a total of 1,530 activity episodes, generalized estimating equation models were developed to examine the relationship between older people's socioeconomic background, activity participation, urban environment characteristics, and their feelings of happiness and calmness. Results show that older people's daily life satisfaction is affected by the emotions they experienced throughout the day. In particular, a higher level of happiness was associated with socializing, leisure, and recreation activities taking place outside of the immediate neighborhood, and calmness was best achieved during passive relaxation and resting activities within the residential neighborhood. Furthermore, characteristics of the environment at activity locations are statistically significant in explaining momentary well-being. The findings support the planning for age-friendly cities and communities through encouraging older people to engage in activities outside their residential neighborhoods and designing activity locations with more leisure facilities, lower road density, and higher exposure to water bodies. [ABSTRACT FROM AUTHOR]

Objective: Individuals with type 1 diabetes (T1D) have increased risk for cognitive dysfunction and high rates of sleep disturbance. Despite associations between glycemia and cognitive performance using cross-sectional and experimental methods few studies have evaluated this relationship in a naturalistic setting, or the impact of nocturnal versus daytime hypoglycemia. Ecological Momentary Assessment (EMA) may provide insight into the dynamic associations between cognition, affective, and physiological states. The current study couples EMA data with continuous glucose monitoring (CGM) to examine the within-person impact of nocturnal glycemia on next day cognitive performance in adults with T1D. Due to high rates of sleep disturbance and emotional distress in people with T1D, the potential impacts of sleep characteristics and negative affect were also evaluated. Methods: This pilot study utilized EMA in 18 adults with T1D to examine the impact of glycemic excursions, measured using CGM, on cognitive performance, measured via mobile cognitive assessment using the TestMyBrain platform. Multilevel modeling was used to test the within-person effects of nocturnal hypoglycemia and hyperglycemia on next day cognition. Results: Results indicated that increases in nocturnal hypoglycemia were associated with slower next day processing speed. This association was not significantly attenuated by negative affect, sleepiness, or sleep quality. Conclusions: These results, while preliminary due to small sample size, showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive fluctuation in real world settings, an approach that may be utilized in other populations. Findings suggest reducing nocturnal hypoglycemia may improve cognition in adults with T1D. [ABSTRACT FROM AUTHOR]

Background: Despite impressive dissemination programs of best-practice therapies, clinical psychology faces obstacles in developing more efficacious treatments for mental disorders. In contrast to other medical disciplines, psychotherapy has made only slow progress in improving treatment outcomes. Improvements in the classification of mental disorders could enhance the tailoring of treatments to improve effectiveness. We introduce a multimodal dynamical network approach, to address some of the challenges faced by clinical research. These challenges include the absence of a comprehensive meta-theory, comorbidity, substantial diagnostic heterogeneity, violations of ergodicity assumptions, and a limited understanding of causal processes. Methods: Through the application of multimodal dynamical network analysis, we describe how to advance clinical research by addressing central problems in the field. By utilizing dynamic network analysis techniques (e.g., Group Iterative Multiple Model Estimation, multivariate Granger causality), multimodal measurements (i.e., psychological, psychopathological, and neurobiological data), intensive longitudinal data collection (e.g., Ecological Momentary Assessment), and causal inference methods (e.g., GIMME), our approach could improve the comprehension and treatment of mental disorders. Under the umbrella of the systems approach and utilizing e.g., graph theory and control theory, we aim to integrate data from longitudinal, multimodal measurements. Results: The multimodal dynamical network approach enables a comprehensive understanding of mental disorders as dynamic networks of interconnected symptoms. It dismantles artificial diagnostic boundaries, facilitating a transdiagnostic view of psychopathology. The integration of longitudinal data and causal inference techniques enhances our ability to identify influential nodes, prioritize interventions, and predict the impact of therapeutic strategies. Conclusion: The proposed approach could improve psychological treatment by providing individualized models of psychopathology and by suggesting individual treatment angles. [ABSTRACT FROM AUTHOR]

Purpose: Research and clinical attention in psychology has focused heavily on negative automatic thoughts and their role in symptoms of psychopathology and maladaptive behavior; however, the role of thoughts that appear to be overly positive in content has received much less attention. Recent work in the cognitive-behavioral treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) has identified overly positive thoughts that may be associated with avoidance and functional impairment. Method: We defined, described, and measured Avoidant Automatic Thoughts (AAT) in the daily lives of 101 undergraduate students using ecological momentary assessment and tested hypotheses about the association of these thoughts with ADHD symptoms and in-the-moment avoidance and negative emotion. Data were collected at baseline and up to three times per day for six days and analyzed using multilevel modeling. Results: We found that AAT were frequent daily occurrences for the undergraduates in our sample and that recent presence of AAT was associated with greater task avoidance and inattentive symptoms at the momentary level. AAT were not, however, associated with momentary negative emotion. Participants' general level of ADHD symptoms predicted greater momentary AAT, task avoidance, negative emotion and negative thoughts and less positive emotion. Conclusions: This study introduces AAT as a construct with potential research and clinical utility for understanding, predicting, and intervening in problematic avoidance behaviors that reduce people's quality of life and prevent them from reaching their meaningful goals. [ABSTRACT FROM AUTHOR]

Emotion-related impulsivity—the engagement in impulsive reactions specifically in response to emotions—is considered a transdiagnostic factor underlying psychopathology. The reflexive responding to emotion (RRE) model of emotion-related impulsivity (Carver et al., 2008) suggests that sensitivities to reward and threat in combination with control over emotion are factors that result in internalizing and externalizing psychopathology. In the current study, we adapt the trait-based RRE model to momentary states by evaluating how within-person fluctuations in affect combine with perceptions of momentary emotional control to predict impulsive, rash action and inaction in daily life. Participants (college students and adults recruited from the community: N = 197) completed 8 days of ecological momentary assessment, where we assessed current affect, perceptions of momentary emotional control (via distress intolerance and willpower), and urges for rash action and inaction (5,353 momentary prompts completed). We also assessed subsequent engagement in rash action and inaction. Using multilevel modeling, we found that when people feel greater positive affect and lower negative affect, they also report greater subjective willpower and lower distress intolerance, replicating past ecological momentary assessment findings. Furthermore, we found that momentary perceptions of momentary emotional control moderated the relationship between (a) affect and urges for rash action and (b) affect and engagement in rash action at follow-up. Findings support a dynamic model of the RRE model, confirming that perceptions of momentary emotional control are relevant for both rash action and inaction, particularly when occurring alongside shifts in affect. General Scientific Summary: The tendency to respond impulsively to emotion is associated with a broad range of psychopathology. To better understand when and for whom emotion-related impulsivity is problematic, we investigated how fluctuations in people's ability to manage emotions are linked to rash behavior throughout the day. Our findings highlight how momentary shifts in affect and emotional control play an important role in people's engagement in rash behavior. [ABSTRACT FROM AUTHOR]

We developed three machine learning models that predict hour-by-hour probabilities of a future lapse back to alcohol use with increasing temporal precision (i.e., lapses in the next week, next day, and next hour). Model features were based on raw scores and longitudinal change in theoretically implicated risk factors collected through ecological momentary assessment. Participants (N = 151, 51% male, Mage = 41, 87% White, 97% non-Hispanic) in early recovery (1–8 weeks of abstinence) from alcohol use disorder provided 4 × daily ecological momentary assessment for up to 3 months. We used grouped, nested cross-validation to select the best models and evaluate the performance of those best models. Models yielded median areas under the receiver operating curves of 0.89, 0.90, and 0.93 in the 30 held-out test sets for week-, day-, and hour-level models, respectively. Some feature categories consistently emerged as being globally important to lapse prediction across our week-, day-, and hour-level models (i.e., past use, future self-efficacy). However, most of the more punctate, time-varying constructs (e.g., craving, past stressful events, arousal) appear to have a greater impact within the next-hour prediction model. This research represents an important step toward the development of a smart (machine learning guided) sensing system that can both identify periods of peak lapse risk and recommend specific supports to address factors contributing to this risk. General Scientific Summary: This study suggests that densely sampled self-report data can be used to predict lapses back to alcohol use with varying degrees of temporal precision. Additionally, the contextual features contributing to the risk of lapse may offer important insight for treatment matching through a digital therapeutic. [ABSTRACT FROM AUTHOR]

Research examining initiation and outcomes of ER has primarily examined when people regulate their own emotions. In the present study, we investigated what predicts the initiation and outcomes of interpersonal emotion regulation (IER). We also examined whether the associations varied by major depressive disorder (MDD), which is characterized by several emotion regulation challenges, including in IER. Adults with and without MDD (N = 215) completed a 14-day EMA protocol, reporting on their emotional experience, recent events, and recent IER interactions. For IER initiation, we examined two features of subjective emotional experiences: participants' affect (negative affect, positive affect) and emotional awareness (attention to emotion, emotional clarity), and two situational characteristics: event unpleasantness and goal interruption. For IER outcomes, we focused on sharing partners' characteristics. Analyses utilized multilevel modeling. We focus on reporting within-person findings. Participants were more likely to initiate IER when the situation was more unpleasant and when goals were interrupted. Regarding IER outcomes, the extent to which participants experienced improved feelings about the problem and relational closeness varied depending on who was the sharing partner. Additionally, perceived warmth of sharing partner was associated with better IER outcomes. Initiating IER did not differ by MDD status, whereas associations between perceived warmth and IER outcomes did. Findings elucidate factors relevant to the IER process and serve to provide important insight into the contexts in which individuals might seek others to support their regulation and when the sharing partner were the most helpful in IER. [ABSTRACT FROM AUTHOR]

Restrained eating has been related to psychological distress like anxiety and eating disorder symptomatology, but little is known about this relationship in daily life in non-clinical populations. We aimed to understand concurrent and temporal associations between momentary anxiety and restrained eating in everyday life within and across persons in a non-clinical sample, and examined whether this association remains after controlling for eating disorder symptomatology. We used a 10-day ecological momentary assessment (EMA) protocol. Participants (n = 123) completed a baseline survey with demographics and eating disorder symptomatology questions, and three EMA surveys per day reporting anxiety and restrained eating intentions. We applied mixed-effects and random intercept cross-lagged models to analyze the data. Momentary anxiety and restrained eating were concurrently significantly positively associated within and between persons. When participants had more anxiety than was typical for them, they were more likely to intend to restrain eating, and people with overall higher anxiety symptoms tended to report greater restrained eating over the study period. These associations remained significant after adjusting for eating disorder symptomatology. There were no significant temporal cross-lagged effects. Anxiety-restrained eating association did not spill over into the next assessment window. The time window between prompts may have been too long to capture potential temporal effects, and we did not examine actual behavioral food restrictions. Daily-life anxiety may be related to concurrent restrained eating intentions, above and beyond baseline eating disorder symptomatology. Research is needed exploring daily-life anxiety as a potential intervention target to address restrained eating. • We examined the associations between anxiety and restrained eating in everyday life. • Momentary anxiety was related to restrained eating intentions within and across persons. • These associations were robust beyond the effect of eating disorder symptomatology. • Anxiety and restrained eating association showed no temporal carry-over effects. • Momentary anxiety is an important aspect to consider in the context of restrained eating. [ABSTRACT FROM AUTHOR]

Dimensional frameworks of psychopathology call for multivariate approaches to map co-occurring disorders to index what symptoms emerge when and for whom. Ecological momentary assessment (EMA) offers a method for assessing and differentiating the dynamics of co-occurring symptoms with greater temporal granularity and naturalistic context. The present study used multivariate mixed effects location-scale modeling to characterize the time-varying dynamics of depressed mood and anxiety for women diagnosed with social anxiety disorder (SAD) and major depression (MDD). Women completed five daily EMA surveys over 30 days (150 EMA surveys/woman, T ≈ 5250 total observations) and two clinical diagnostic and retrospective self-report measures administered approximately two months apart. There was evidence of same-symptom lagged effects (bs = 0.08–0.09), but not cross-symptom lagged effects (b s < 0.01) during EMA. Symptoms co-varied such that momentary spikes from one's typical level of anxiety were associated with increases in momentary depressed mood (b = 0.19) and greater variability of depressed mood (b = 0.06). Similarly, spikes from one's typical levels of depressed mood were associated with increases in momentary anxiety (b = 0.19). Furthermore, the presence and magnitude of effects demonstrated person-specific heterogeneity. Our findings are constrained to the dynamics of depressed and anxious mood among cisgender women with primary SAD and current or past MDD. Findings from this work help to characterize how daily experiences of co-occurring mood and anxiety fluctuate and offer insight to aid the development of momentary, person-specific interventions designed to regulate symptom fluctuations. • The nature of covariation in mood and anxiety varies from person to person. • Multivariate mixed effects location-scale modeling was used. • Momentary spikes in one symptom were associated with increases in the other. • The presence and magnitude of effects demonstrated person-specific heterogeneity. • Findings inform the design of momentary, person-specific interventions. [ABSTRACT FROM AUTHOR]

Social interactions, spending time together, and relationships are important for individuals' well-being, with people feeling happier when they spend more time with others. So far, most information about the frequency and duration of spending time together is based on self-report questionnaires. Although recent technological innovations have stimulated the development of objective approaches for measuring physical proximity in humans in everyday life, these methods still have substantial limitations. Here we present a novel method, using Bluetooth low-energy beacons and a smartphone application, to measure the frequency and duration of dyads being in close proximity in daily life. This method can also be used to link the frequency and duration of proximity to the quality of interactions, by using proximity-triggered questionnaires. We examined the use of this novel method by exploring proximity patterns of family interactions among 233 participants (77 Dutch families, with 77 adolescents [Mage = 15.9] and 145 parents [Mage = 48.9]) for 14 consecutive days. Overall, proximity-based analyses indicated that adolescents were more often and longer in proximity to mothers than to fathers, with large differences between families in frequency and duration. Proximity-triggered evaluations of the interactions and parenting behavior were generally positive for both fathers and mothers. This innovative method is a promising tool that can be broadly used in other social contexts to yield new and more detailed insights into social proximity in daily life. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion Although social media use, such as Instagram, has been associated with ED pathology, mechanisms connecting social media use to disordered eating behaviors (DEBs) remain largely unevaluated. Based on Dual Process, Tripartite, and Affect Regulation models of ED pathology, we proposed a moderated mediation model evaluating impacts of exposure to fitspiration/thinspiration on Instagram.We evaluated a hypothesized pathway from exposure to fitspiration/thinspiration (i.e., ED‐salient content) on Instagram to disordered eating mediated by negative affect and tested individual differences in weight bias internalization, trait self‐esteem, and trait self‐comparison as moderators. We recruited 173 undergraduate women who reported engaging in DEBs on average at least once per week over the past 3 months. Participants completed a seven‐day ecological momentary assessment protocol, during which they reported their ED‐salient content exposure on Instagram, affect, and engagement in DEBs.Multilevel modeling was used to assess moderated mediation. Negative affect partially mediated associations between viewing ED‐salient content and subsequent engagement in objective binge eating and restricting but did not mediate the pathway to purging or excessive exercise. Higher weight bias internalization intensified the association between viewing ED‐salient content and negative affect.The association between viewing ED‐salient content and engaging in objective binge eating and restricting may be a partial consequence of elevated negative affect; however, effects were small. Individuals with higher weight bias internalization may be more vulnerable to negative consequences from viewing ED‐salient content. Findings suggested that reducing negative affect responses (e.g., via emotion regulation) could reduce negative consequences of viewing ED‐salient content. [ABSTRACT FROM AUTHOR]

The effects of heat exposure on negative affect are thought to be central to the observed relationships between hot summer days and deleterious outcomes, such as violent crime or mental health crises. As these relationships are likely to be magnified by the effects of climate change, a better understanding of how consistent or variable the effects of hot weather on affective states is required. The current work combines data gathered from an ecological momentary assessment (EMA) study on individuals' thermal perceptions, comfort, and affective states in outdoor environments during their daily lives with high spatiotemporal resolution climate-modeled weather variables. Using these data, associations between objective weather variables (temperature, humidity, etc.), perceived heat (thermal perception and comfort), and affective states are examined. Overall, objective weather data reasonably predicted perception and comfort, but only comfort predicted negative affective states. The variance explained across individuals was generally very low in predicting negative affect or comfort, but within-person variance explained was high. In other words, while there may be a relatively consistent relationship between temperature and psychological experience for any given person, there are significant individual differences across people. Age and gender were examined as moderators of these relationships, and while gender had no impact, participant age showed several significant interactions. Specifically, while older adults tended to experience more thermal discomfort and perceived higher temperatures as hotter, the relationship between discomfort and negative affect was lower in older adults. Taken together, these results emphasize the importance of thermal discomfort specifically in predicting negative affect, as well as the high inter-individual variability in thermal perceptions and comfort for the same ambient temperatures. [ABSTRACT FROM AUTHOR]

Ecological momentary assessment (EMA), a data collection method commonly employed in mHealth studies, allows for repeated real‐time sampling of individuals' psychological, behavioral, and contextual states. Due to the frequent measurements, data collected using EMA are useful for understanding both the temporal dynamics in individuals' states and how these states relate to adverse health events. Motivated by data from a smoking cessation study, we propose a joint model for analyzing longitudinal EMA data to determine whether certain latent psychological states are associated with repeated cigarette use. Our method consists of a longitudinal submodel—a dynamic factor model—that models changes in the time‐varying latent states and a cumulative risk submodel—a Poisson regression model—that connects the latent states with the total number of events. In the motivating data, both the predictors—the underlying psychological states—and the event outcome—the number of cigarettes smoked—are partially unobservable; we account for this incomplete information in our proposed model and estimation method. We take a two‐stage approach to estimation that leverages existing software and uses importance sampling‐based weights to reduce potential bias. We demonstrate that these weights are effective at reducing bias in the cumulative risk submodel parameters via simulation. We apply our method to a subset of data from a smoking cessation study to assess the association between psychological state and cigarette smoking. The analysis shows that above‐average intensities of negative mood are associated with increased cigarette use. [ABSTRACT FROM AUTHOR]

Purpose: Emotional eating during negative emotions might underlie disordered eating behavior (i.e., binge eating and food restriction). Positive emotions, by contrast, seem to promote healthier eating behavior. Naturalistic research on the links between emotions and eating across individuals with binge-eating disorder (BED), bulimia nervosa (BN), binge-purge anorexia nervosa (AN-BP), and restrictive anorexia nervosa (AN-R) is, however, lacking. Methods: Individuals without eating disorders (comparison group, CG, n = 85), and patients with BED (n = 41), BN (n = 50), AN-BP (n = 26), and AN-R (n = 29) participated in an ecological momentary assessment study. Six daily notifications over eight days prompted ratings of momentary food craving and emotional states differing in valence and arousal. Results: Results supported specific emotion-food-craving patterns in each group. Compared to the CG, arousing negative emotions and higher cravings co-occurred in patients with BN. In patients with AN-BP (at trend level also in patients with AN-R) less arousing negative emotions and lower cravings co-occurred. In patients with AN, positive emotions and higher cravings co-occurred whereas in patients with BED less arousing positive emotions and lower cravings co-occurred. Conclusion: The found emotion-craving associations may underlie group-specific (dys-)functional eating behaviors, i.e., binge eating and food restriction during negative emotions in patients with BN and AN, and normalized appetitive responses during positive emotions in patients with BED and AN. Therapeutic efforts could target arousing negative emotions in patients with BN, and less arousing negative emotions in patients with AN. Positive emotions could be used in a salutogenetic approach in patients with BED and AN. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusion Many patients with eating disorders (EDs) engage in excessive and compulsive physical activity (pathological exercise, PE) to regulate negative mood or to “burn calories.” PE can lead to negative health consequences. Non‐exercise activity (NEA) bears the potential to serve as intervention target to counteract PE and problematic eating behaviors since it has been associated with positive mood effects. However, to date, there is no investigation on whether the positive link between NEA and mood seen in the healthy translates to patients with ED.To study potential associations of NEA and mood in ED, we subjected 29 ED‐patients and 35 healthy controls (HCs) to an ambulatory assessment study across 7 days. We measured NEA via accelerometers and repeatedly assessed mood on electronic smartphone diaries via a mixed sampling strategy based on events, activity and time. Within‐ and between‐subject effects of NEA on mood, PE as moderator, and the temporal course of effects were analyzed via multilevel modeling.NEA increased valence (β = 2.12, p < 0.001) and energetic arousal (β = 4.02, p < 0.001) but showed no significant effect on calmness. The effects of NEA on energetic arousal where significantly stronger for HCs (βHC = 6.26, p < 0.001) than for EDs (βED = 4.02, p < 0.001; βinteraction = 2.24, p = 0.0135). Effects of NEA were robust across most timeframes of NEA and significantly moderated by PE, that is, Lower PE levels exhibited stronger NEA effects on energetic arousal.Patients with ED and HC show an affective benefit from NEA, partly depending on the level of PE. If replicated in experimental daily life studies, this evidence may pave the way towards expedient NEA interventions to cope with negative mood. Interventions could be especially promising if delivered as Just‐in‐time adaptive interventions (JITAIs) and should be tailored according to the PE level. [ABSTRACT FROM AUTHOR]

Background: Unhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date. This paper describes a research study protocol of an integrated telehealth intervention to reduce unhealthy drinking and chronic pain among PLWH (Motivational and Cognitive-Behavioral Management for Alcohol and Pain [INTV]). Methods: Two-hundred and fifty PLWH with unhealthy drinking and chronic pain will be recruited nationally via online advertisement. Informed consent and baseline assessments occur remotely, followed by 15 days of ecological momentary assessment to assess alcohol use, chronic pain, functioning, and mechanisms of behavior change. Next, participants will be randomized to either the INTV or Control (CTL) condition. Individuals in both conditions will meet with a health counselor through videoconferencing following randomization, and those in the INTV condition will receive 6 additional sessions. At 3- and 6-months post-baseline, participants will complete outcome assessments. It is hypothesized that the INTV condition will result in reduced unhealthy alcohol use and pain ratings compared to the CTL condition. Conclusion: This protocol paper describes a randomized controlled trial which tests the efficacy of a novel, integrated telehealth approach to reduce unhealthy alcohol use and chronic pain for PLWH, two common comorbid conditions that influence the HIV treatment cascade. ClinicalTrials.gov identifier: NCT05503173. Highlights: Unhealthy alcohol use and chronic pain are common in people living with HIV. An integrated telehealth intervention may improve alcohol, pain, and HIV outcomes. Ecological momentary assessment will examine processes underlying behavior change. [ABSTRACT FROM AUTHOR]

Background: Psychotic spectrum disorders (PSD) are associated with poor social function. In this study, we investigate which of two different types of 2-month long training courses is more effective in improving day-to-day interactions and quality of life. Methods/design: Participants with psychotic spectrumdisorders will be randomly assigned to one of two training courses. Social functioning, everyday activities, social cognition and symptoms will be assessed at multiple timepoints, including baseline, treatment midpoint, end of treatment and 2-month follow-up. One training focuses on howto make good judgments about what other peoplemay be thinking or feeling in social situations, and why people might act in certain ways in different situations. The other training focuses on different strategies for handling everyday problems and stressors. Both trainings are done in one-on-one sessions with a research staff member. There will be 16-20 training sessions, each about 45-60 minutes long. The investigators will ask participants to attend 2 training sessions per week, so the total training time should be about 2 months. [ABSTRACT FROM AUTHOR]

Social anhedonia is a hallmark symptom of schizophrenia. Discrepancies in anticipated versus consummatory pleasure for non-social stimuli are well-documented. Thus, a similar emotional paradox may underlie social anhedonia. If so, our understanding of social anhedonia—including how to treat it in schizophrenia—could be enhanced. This project used a 5-day experience sampling method (ESM) to measure discrepancies between anticipated and consummatory pleasure for real-world social activities in people with schizophrenia and healthy controls (n = 30/group). ESM results were compared to laboratory assessments of negative symptoms and neurocognition. The schizophrenia group exhibited similar levels of anticipated and consummatory social pleasure as controls throughout daily life, and both groups were accurate in their short-term predictions of pleasure. Clinical interviews revealed those with schizophrenia showed significant deficits in long-term social pleasure prediction (i.e., a 1-week timeframe). Thus, people with schizophrenia may exhibit differences in ability to predict pleasure in the short-term versus the long-term. Negative symptoms and neurocognition were related to anticipated, but not consummatory, social pleasure, suggesting anhedonia is driven by deficits in thinking about pleasure, rather than inability to experience pleasure. Clinical implications include focusing on building upon short-term ability to predict pleasure in therapy to increase social motivation in schizophrenia. • People with schizophrenia report as much social pleasure in daily life as controls. • Those with schizophrenia can accurately predict social pleasure in the short-term. • Those with schizophrenia show deficits in long-term social pleasure prediction. • Cognitive impairment is implicated in ability to predict social pleasure. [ABSTRACT FROM AUTHOR]

Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined. [ABSTRACT FROM AUTHOR]

Ecological momentary assessment (EMA) allows for the collection of participant-reported outcomes (PROs), including pain, in the normal environment at high resolution and with reduced recall bias. Ecological momentary assessment is an important component in studies of pain, providing detailed information about the frequency, intensity, and degree of interference of individuals' pain. However, there is no universally agreed on standard for summarizing pain measures from repeated PRO assessment using EMA into a single, clinically meaningful measure of pain. Here, we quantify the accuracy of summaries (eg, mean and median) of pain outcomes obtained from EMA and the effect of thresholding these summaries to obtain binary clinical end points of chronic pain status (yes/no). Data applications and simulations indicate that binarizing empirical estimators (eg, sample mean, random intercept linear mixed model) can perform well. However, linear mixed-effect modeling estimators that account for the nonlinear relationship between average and variability of pain scores perform better for quantifying the true average pain and reduce estimation error by up to 50%, with larger improvements for individuals with more variable pain scores. We also show that binarizing pain scores (eg, <3 and ≥3) can lead to a substantial loss of statistical power (40%-50%). Thus, when examining pain outcomes using EMA, the use of linear mixed models using the entire scale (0-10) is superior to splitting the outcomes into 2 groups (<3 and ≥3) providing greater statistical power and sensitivity. [ABSTRACT FROM AUTHOR]

[Display omitted] • First ecological momentary assessment study to examine emotion dysregulation in OCD. • More avoidance-oriented strategies in OCD vs. healthy controls. • Less positive affect and regulatory effectiveness in OCD vs. healthy controls. • Results remain significant controlling for symptoms, negative affect or depression. • Negative affect is related to more avoidance, less effectiveness, and acceptance. Emotion dysregulation is a central process implicated in the genesis and maintenance of obsessive-compulsive disorder (OCD). However, past research on OCD has examined emotion regulation with a trait-level approach, thereby neglecting important situational and temporal dynamics. The present study is the first one to examine moment-to-moment emotion regulation in individuals with OCD. A 6-day ecological momentary assessment was used to assess affect, emotion regulation strategies, perceived effectiveness of emotion regulation strategies, and acceptance of emotional experiences in n = 72 individuals with OCD and n = 54 psychologically healthy controls. As expected, individuals with OCD reported more negative and less positive affect. Group differences in positive (but not negative) affect did remain significant when controlling for baseline depression. Furthermore, the OCD group reported to use a higher momentary number of avoidance-oriented regulation strategies and less perceived effectiveness of emotion regulation, even when controlling for current symptoms and negative affect or baseline depression scores. Further, irrespective of group, more momentary negative affect amplified use of avoidance-oriented strategies and diminished perceived effectiveness and emotional acceptance. Contrary to expectations, these effects were not more pronounced in the OCD group. Possible explanations for unexpected findings and implications for future research, particularly regarding more holistic emotion regulation treatments, are discussed. [ABSTRACT FROM AUTHOR]

Children vary in how sensitive they are to experiences, with consequences for their developmental outcomes. In the current study, we investigated how behavioral sensitivity at age 3 years predicts mental health in middle childhood. Using a novel repeated measures design, we calculated child sensitivity to multiple psychological and social influences: parent praise, parent stress, child mood, and child sleep. We conceptualized sensitivity as the strength and direction of the relationship between psychosocial influences and child behavior, operationalized as toothbrushing time, at age 3 years. When children were 5–7 years old (n = 60), parents reported on children's internalizing and externalizing problems. Children who were more sensitive to their parents' praise at age 3 had fewer internalizing (r = −0.37, p = 0.016, pFDR = 0.042) and externalizing (r = −0.35, p = 0.021, pFDR = 0.042) problems in middle childhood. Higher average parent praise also marginally predicted fewer externalizing problems (r = −0.33, p = 0.006, pFDR = 0.057). Child sensitivity to mood predicted fewer internalizing (r = −0.32, p = 0.013, pFDR = 0.042) and externalizing (r = −0.38, p = 0.003, pFDR = 0.026) problems. By capturing variability in how children respond to daily fluctuations in their environment, we can contribute to the early prediction of mental health problems and improve access to early intervention services for children and families who need them most. Research Highlights: Children differ in how strongly their behavior depends on psychosocial factors including parent praise, child mood, child sleep, and parent stress.Children who are more sensitive to their parents' praise at age 3 have fewer internalizing and externalizing problems at age 5–7 years.Child sensitivity to mood also predicts fewer internalizing and externalizing problems. [ABSTRACT FROM AUTHOR]

Clinician collaboration can help high-risk individuals to manage their suicidal crises. However, limited research has directly examined how higher patient-clinician collaboration during assessment and intervention can effectively reduce suicidal ideation. This novel randomized clinical trial compared a high vs. low level of patient-clinician collaboration by pairing commonly used assessment (Structured Interview vs. Narrative Assessment) and intervention approaches (Safety Planning Intervention vs. Crisis Response Planning). We hypothesized that the interventions involving higher (than lower) patient-clinician collaboration during assessment (Narrative Assessment) or intervention (Crisis Response Planning) would lead to larger reductions in suicidal ideation. Eighty-two participants with a history of suicide ideation and/or attempts were randomly assigned to one of the four interventions varying in patient-clinician collaboration. After attrition, sixty-six participants completed the study. Suicidal ideation via ecological momentary assessment was measured 14 days before and 14 days after treatment. Although the severity of suicidal ideation decreased in all groups, the two groups that included highly collaborative assessment had larger pre-post reductions in suicidal ideation (Narrative Assessment+Safety Plan; d within = 0.26, and Narrative Assessment+Crisis Response Plan; d within = 0.19) than the groups that included a checklist-based assessment (Structured Interview). Longer follow-up periods with a larger sample would have provided an understanding of the durability of intervention effects. Results suggest that the inclusion of higher patient-clinician collaboration techniques during suicide risk assessment can effectively reduce suicidal thoughts. Thus, clinician-led collaborative risk assessment approaches can enhance the effects of safety planning-type interventions among patients with elevated risk for suicide versus checklist-based assessment approaches. • Higher clinician-led collaboration via Narrative assessment reduces suicide risk. • Narrative assessment paired with Safety Plan Intervention reduces suicidal thoughts. • Narrative assessment paired with a Crisis Response Plan reduces suicidal thoughts. • Collaborative risk assessments can enhance safety planning-type interventions. [ABSTRACT FROM AUTHOR]

Evidence suggests that loneliness causes people to feel more depressed. It is unknown, however, why this association occurs and whether momentary versus chronic experiences of loneliness are implicated. Theoretical accounts suggest that momentary feelings of loneliness produce two competing motivations: social reaffiliation and social withdrawal. Social affiliation is protective against depression; social withdrawal, in contrast, is a risk factor. Thus, engaging in frequent and high-quality interactions following experiences of loneliness may protect against subsequent depression. We tested this hypothesis using a random-interval experience sampling design (5x/day/day, 14 days; Nobs = 6568) with a racially/ethnically diverse sample of adults with elevated depression symptoms (N = 102). Momentary loneliness was associated with depressed mood at the same time point and ∼2.5h and ∼5h later. Frequency and quality of social interaction did not moderate these associations. Findings suggest that momentary feelings of loneliness may be an important target for clinical intervention. • Evidence suggests that loneliness is causally associated with depression. • It is unclear whether momentary vs. chronic feelings of loneliness cause depression. • Features of social interactions (e.g., quantity) may buffer against subsequent depression. • Results showed that loneliness was associated with depression at the same time point and ∼2.5 and ∼5 hours later. • Neither social interaction quantity, satisfaction, self- and other-disclosure, nor responsiveness moderated this association. [ABSTRACT FROM AUTHOR]

Ecological Momentary Assessment (EMA) holds promise for providing insights into daily life experiences when studying mental health phenomena. However, commonly used mixed-effects linear statistical models do not fully utilize the richness of the ultidimensional time-varying data that EMA yields. Recurrent Neural Networks (RNNs) provide an alternative data analytic method to leverage more information and potentially improve prediction, particularly for non-normally distributed outcomes. As part of a broader research study of suicidal thoughts and behavior in people with borderline personality disorder (BPD), eighty-four participants engaged in EMA data collection over one week, answering questions multiple times each day about suicidal ideation (SI), stressful events, coping strategy use, and affect. RNNs and mixed-effects linear regression models (MEMs) were trained and used to predict SI. Root mean squared error (RMSE), mean absolute percent error (MAPE), and a pseudo-R2 accuracy metric were used to compare SI prediction accuracy between the two modeling methods. RNNs had superior accuracy metrics (full model: RMSE = 3.41, MAPE = 42 %, pseudo-R2 = 26 %) compared with MEMs (full model: RMSE = 3.84, MAPE = 56 %, pseudo-R2 = 16 %). Importantly, RNNs showed significantly more accurate prediction at higher values of SI. Additionally, RNNs predicted, with significantly higher accuracy, the SI scores of participants with depression diagnoses and of participants with higher depression scores at baseline. In this EMA study with a moderately sized sample, RNNs were better able to learn and predict daily SI compared with mixed-effects models. RNNs should be considered as an option for EMA analysis. • Recurrent Neural Networks had superior predictive ability for Suicidal Ideation compared to Mixed-Effects Models • Both methods were less accurate in the higher range of Suicidal Ideation values • Recurrent Neural Networks performed better for high values than Mixed-Effects Models, and for those with depression symptoms • Proposed extensions of Recurrent Neural Network modeling further improved prediction accuracy in the high ideation range [ABSTRACT FROM AUTHOR]

Objectives: A healthy diet is essential for preventing chronic disease and promoting overall health. Translating one's intention to eat healthy into actual behaviour has, however, proven difficult with a range of internal and contextual factors identified as driving eating behaviour. Design: We leverage Temporal Self‐Regulation Theory to examine these momentary determinants' direct and moderating effects on the intention–behaviour relation with Ecological Momentary Assessment (EMA). Methods: Eighty‐seven healthy participants (mage = 24.1 years; 59 women, 28 men) reported, 5 times daily for 10 weekdays, their intentions to stick to a self‐set dietary restriction goal for the next 3 hr, the goal congruency of their eating behaviour in the past 3 hr, and a range of factors potentially influencing food intake, such as stress, emotions and environmental eating cues. Results: Two‐part multilevel modelling revealed that craving, availability of goal‐incongruent foods, social eating cues, giving in to other temptations and weaker momentary intentions directly increased the risk and severity of goal‐incongruent intake within the next 3 hr. Social cues, stress and craving further influence behaviour through altering intention implementation. Conclusions: Results imply that people regularly fail to implement intentions for 3‐hr periods and that a range of factors influences this, both directly and by disrupting intentional processes. While for some barriers, fostering strong intentions throughout the day could be beneficial, others require different strategies for dietary adherence. [ABSTRACT FROM AUTHOR]

The experience sampling method (ESM) allows for a high degree of ecological validity compared to laboratory research, at the cost of greater effort for participants. It would therefore benefit from implementations that reduce participant effort. In the present paper, we introduce a screenless wrist-worn one-button wearable as an unobtrusive measurement method that can be employed in ESM designs. We developed an open-source Android application to make this commercially available wearable easily configurable and usable. Over the course of six pilot studies, we explored the technical viability (e.g., battery life, reliability of inputs) of this wearable. We compared data quality between wearables and smartphones in a within-subjects design, exploring both the input options of using the number of button presses as a Likert scale, as well as using the angle of the device as a Physical Analogue Scale. Assessments of Extraversion made with either of these methods were highly correlated to comparable assessments made with comparable methods on a smartphone (i.e., Likert scale or a Visual Analogue Scale, respectively). Furthermore, in a preregistered ESM field experiment (N = 134, 4 weeks), we compared compliance to real-life event triggers between wearable devices and smartphones. We found higher numbers of logged events in the wearable group, indicating better adherence to the event-contingent scheduling. Overall, despite the device's minimal capabilities and resulting limitations, one-button wearables can be beneficial for use in ESM designs. [ABSTRACT FROM AUTHOR]

Although suicide is complex and heterogeneous, most suicide theories assume that suicidal urges occur primarily in the context of extreme emotional distress. Newer models of suicide based on complex systems theory propose greater heterogeneity in suicidal experiences across individuals and groups, such that some, but not all, suicidal thoughts, urges, and behaviors are associated with extreme negative affect. The present study investigated individual differences in affective states experienced during suicidal urges among 138 adults recruited from the community; 81 (59.1 %) owned handguns and 57 (41.6 %) did not. Participants self-reported their current affect and urge to kill themselves 6 times per day for 28 consecutive days via ecological momentary assessment. Positive and negative affect ratings varied significantly during suicidal urges. The association of positive and negative affect with suicidal urges significantly varied within and between handgun owners and non-owners. Results suggest suicidal urges are characterized by high affective heterogeneity. • Little is known about the range of affect experienced during suicidal states • Affect and suicidal urges were assessed repeatedly using ecological momentary assessment • Affect during suicidal urges ranged considerably across individuals • The relationship of affect and suicidal urges also ranged considerably • The relationship of affect and suicidal urges was weaker among handgun owners [ABSTRACT FROM AUTHOR]

Switching between different emotion regulation strategies may promote mental health by helping match strategy use to different situations. However, switching strategies very frequently might undermine any given regulation attempt. Individuals with high levels of self-reported neuroticism may have trouble finding the right balance of strategy switching versus persistence given increased negative emotionality and impulsivity; yet it is unclear whether this difficulty is characterized by too much switching, too little switching, or both. As such, we tested whether high or low rates of strategy switching within daily life was associated with trait neuroticism. We quantified how N = 89 college students switched between 20 strategies to regulate positive emotions and 20 strategies to regulate negative emotions when sampled three times daily for 10 days. We tested whether the linear or quadratic effects of strategy switching—when measured across all 20 positive emotion- or all 20 negative emotion-focused strategies, and within smaller classes of related strategies—were associated with neuroticism. We found that lower rates of switching amongst all strategies used to regulate negative emotions, and specifically amongst the adaptive engagement strategies, was associated with higher rates of neuroticism. Moderate switching amongst the aversive cognitive perseveration strategies, by contrast, was associated with higher neuroticism. Switching amongst strategies used to regulate positive emotions was not associated with neuroticism at the overall or class level. This pre-registered study suggests that neuroticism is associated with unique patterns of strategy switching in response to negative—but not necessarily positive—emotions in daily life. [ABSTRACT FROM AUTHOR]

Introduction: Negative urgency is a personality pathway toward impulsive behavior that increases risk for transdiagnostic psychopathology. Limited research supports the core tenant of urgency theory, that is, that individuals with high trait negative urgency act more impulsive when experiencing increased negative emotion. We hypothesized that it may not be negative emotion intensity, but difficulty in differentiating among negative emotions, that prompts impulsive behavior among individuals with elevated negative urgency. Methods: We tested this hypothesis in 200 undergraduates using both ecological momentary assessment (measured momentary undifferentiated negative affect and impulsivity) and experimental methods (manipulated emotion differentiation and measured behavioral impulsivity). Results: Momentary undifferentiated negative affect predicted impulsivity in the specific domains of work/school and exercise, but interactions between momentary undifferentiated negative affect and negative urgency were not supported. Manipulated emotion differentiation did not impact behavioral impulsivity regardless of negative urgency scores. Conclusion: Inconsistent with theory, the impulsive behavior of individuals with negative urgency may not be conditional on elevated or undifferentiated negative affect. [ABSTRACT FROM AUTHOR]