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Data collected with the Experience Sampling Method (ESM) have been increasingly used to investigate individuals’ behaviours, emotions, and thoughts in daily life. Typically, linear mixed-effect models are used to analyze these data. This model is widely used in ESM research because it allows partitioning of the variability in the data into variance at the individual level and at the measurement level. However, the implementation of linear mixed-effect models presents challenges when analyzing statistically rare phenomena. For example, suicidal thoughts and behaviors within non-clinical populations, psychopathology symptoms (e.g., insomnia), or negative emotions (e.g., anger). In ESM studies it has been observed that certain items (e.g., suicidal thoughts and behaviors, negative affect items) include a large number of zeros, representing moments in which participants have not experienced them. Meanwhile, the non-zero participants’ responses to these behaviors or emotions are positive skewed continuous variables. The two-part semi-continuous mixed-effect regression has been proposed to model a variable in which a portion of the responses are equal to a single value, that represents whether an individual engaged in the target behaviour or they experience a certain emotion, and a continuous and skewed distribution for the remaining values. In this paper, we present an application of the two-part semi-continuous mixed-effect model to analyze semi-continuous ESM outcomes with a large number of zeros. Specifically, we use pre-existing data from four ESM studies to investigate the consequences of model misspecification (i.e., when we fit a linear mixed-effect model but responses follow a two-part semicontinuous distribution). We also compare the predictive accuracy of linear and two-part mixed-effect models as a function of the sample size. The paper includes a tutorial that researchers can use to evaluate estimation and predictive accuracy, and calculate statistical power for semi-continuous outcomes in ESM data.

There is evidence that exposure to negative news is making people feel bad, but not much is known about why this only affects some people or whether this also applies to everyday news exposure. This study examined the direct and indirect effects of daily news exposure on people's affective states. Using ecological momentary assessment (EMA), 63 respondents (24 men and 39 women) reported their news exposure and affective states five times a day for 10 days. In addition, personal relevance of the news and personality characteristics, neuroticism and extraversion, were assessed. Results showed that negative news perceptions were related to more negative affect and less positive affect, and these effects were moderated by personal relevance, but not personality characteristics. The implications of these outcomes are discussed.

OBJECTIVE: To test whether polygenic risk score for schizophrenia (PRS-S) interacts with childhood adversity and daily-life stressors to influence momentary mental state domains (negative affect, positive affect, and subtle psychosis expression) and stress-sensitivity measures. METHODS: The data were retrieved from a general population twin cohort including 593 adolescents and young adults. Childhood adversity was assessed using the Childhood Trauma Questionnaire. Daily-life stressors and momentary mental state domains were measured using ecological momentary assessment. PRS-S was trained on the latest Psychiatric Genetics Consortium schizophrenia meta-analysis. The analyses were conducted using multilevel mixed-effects tobit regression models. RESULTS: Both childhood adversity and daily-life stressors were associated with increased negative affect, decreased positive affect, and increased subtle psychosis expression, while PRS-S was only associated with increased positive affect. No gene-environment correlation was detected. There is novel evidence for interaction effects between PRS-S and childhood adversity to influence momentary mental states [negative affect (b = 0.07, P = 0.013), positive affect (b = -0.05, P = 0.043), and subtle psychosis expression (b = 0.11, P = 0.007)] and stress-sensitivity measures. CONCLUSION: Exposure to childhood adversities, particularly in individuals with high PRS-S, is pleiotropically associated with emotion dysregulation and psychosis proneness. ispartof: ACTA PSYCHIATRICA SCANDINAVICA vol:141 issue:5 pages:465-475 ispartof: location:United States status: published

Aims Childhood trauma is associated with an elevated risk for psychosis, but the psychological mechanisms involved remain largely unclear. This study aimed to investigate emotional and psychotic stress reactivity in daily life as a putative mechanism linking childhood trauma and clinical outcomes in individuals at ultra-high-risk (UHR) for psychosis. Methods Experience sampling methodology was used to measure momentary stress, affect and psychotic experiences in the daily life of N = 79 UHR individuals in the EU-GEI High Risk Study. The Childhood Trauma Questionnaire was used to assess self-reported childhood trauma. Clinical outcomes were assessed at baseline, 1- and 2-year follow-up. Results The association of stress with positive (β = −0.14, p = 0.010) and negative affect (β = 0.11, p = 0.020) was modified by transition status such that stress reactivity was greater in individuals who transitioned to psychosis. Moreover, the association of stress with negative affect (β = 0.06, p = 0.019) and psychotic experiences (β = 0.05, p = 0.037) was greater in individuals exposed to high v. low levels of childhood trauma. We also found evidence that decreased positive affect in response to stress was associated with reduced functioning at 1-year follow-up (B = 6.29, p = 0.034). In addition, there was evidence that the association of childhood trauma with poor functional outcomes was mediated by stress reactivity (e.g. indirect effect: B = −2.13, p = 0.026), but no evidence that stress reactivity mediated the association between childhood trauma and transition (e.g. indirect effect: B = 0.14, p = 0.506). Conclusions Emotional and psychotic stress reactivity may be potential mechanisms linking childhood trauma with clinical outcomes in UHR individuals.

BackgroundPsychotic experiences, social functioning and general psychopathology are important targets for early intervention in individuals with Ultra-High-Risk state (UHR) and a first-episode psychosis (FEP). Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets, but evidence on sustainable change and its underlying mechanisms in individuals’ daily lives remains limited. The aim of the INTERACT study is to investigate the efficacy of a novel ecological momentary intervention, Acceptance and Commitment Therapy in Daily Life (ACT-DL) in a multi-centre randomised controlled trial of individuals with UHR or FEP.Methods/designIn a multi-centre randomised controlled trial, individuals aged 16–65 years with UHR or FEP will be randomly allocated to ACT-DL in addition to treatment as usual (TAU) as the experimental condition or a control condition of TAU only, which will include – for the entire study period – access to routine mental health care and, where applicable, CBT for psychosis (CBTp). Outcomes will be assessed at baseline (i.e. before randomisation), post-intervention (i.e. after the 8-week intervention period), and 6-month and 12-month follow-ups (i.e. 6 and 12 months after completing the intervention period) by blinded assessors. The primary outcome will be distress associated with psychotic experiences, while secondary outcomes will include (momentary) psychotic experiences, social functioning and psychopathology. Process measures to assess putative mechanisms of change will include psychological flexibility, stress sensitivity and reward experiences. In addition, acceptability, treatment adherence and treatment fidelity of ACT-DL will be assessed.DiscussionThe current study is the first to test the efficacy of ACT-DL in individuals with UHR and FEP. If this trial demonstrates the efficacy of ACT-DL, it has the potential to significantly advance the treatment of people with UHR and FEP and, more generally, provides initial support for implementing mHealth interventions in mental health services.Trial registrationNetherlands Trial Register, ID:NTR4252. Registered on 26 September 2013.

Objective Self-monitoring is crucial to raise awareness for own behaviors and emotions, and thus facilitate self-management. The composition of self-monitoring within interventions, however, varies and guidelines are currently unavailable. This review aimed to provide a comprehensive overview of technology-based self-monitoring interventions that intend to improve health in middle-aged and older adults (>45 years). Methods Five online databases were systematically searched and articles were independently screened. A narrative synthesis of 26 studies with 21 unique interventions was conducted. Primary focus lay on the composition of self-monitoring within interventions, including technology used, health-aspects monitored, and type of feedback provided. Secondly, the usability of/adherence to the self-monitoring treatment, intervention effects, and their sustainability were examined. Findings Studies concentrated on middle-aged adults (mean of 51 years). Mobile technologies seem necessary to ensure flexible self-monitoring in everyday life. Social health aspects were rarely monitored. Mechanisms and the sustainability of intervention effect are understudied. Conclusion Digital self-monitoring technologies hold promise for future trials as they seem suitable to understand and support health-related self-management. Key elements including automatic and personal feedback following the blended care principle were highlighted and may guide study designs. Prospectively, research is especially needed to study sustained self-monitoring to support disease prevention and lasting lifestyle changes., Highlights • Digital self-monitoring interventions for middle-aged and older adults show great diversity. • Mobile technologies (e.g. smartphones) are needed for flexible self-monitoring. • Social health aspects (e.g. social networks/company) are rarely monitored. • Mechanisms and sustainability of intervention effects are understudied. • More research is needed on prevention and lasting lifestyle changes.

Purpose: The aim of the current study was to replicate findings in adults indicating that higher sensitivity to stressful events is predictive of both onset and persistence of psychopathological symptoms in a sample of adolescents and young adults. In addition, we tested the hypothesis that sensitivity to mild stressors in particular is predictive of the developmental course of psychopathology.Methods: We analyzed experience sampling and questionnaire data collected at baseline and one-year follow-up of 445 adolescent and young adult twins and non-twin siblings (age range: 15-34). Linear multilevel regression was used for the replication analyses. To test if affective sensitivity to mild stressors in particular was associated with follow-up symptoms, we used a categorical approach adding variables on affective sensitivity to mild, moderate and severe daily stressors to the model.Results: Linear analyses showed that emotional stress reactivity was not associated with onset (beta = .02; P =.56) or persistence (beta = -01; P = .78) of symptoms. There was a significant effect of baseline symptom score (beta = .53; P Discussion: We were unable to replicate previous findings relating stress sensitivity linearly to symptom onset or persistence in a younger sample. Whereas sensitivity to more severe stressors may reflect adaptive coping, high sensitivity to the mildest of daily stressors may indicate an increased risk for psychopathology. (C) 2017 Published by Elsevier Masson SAS.

Purpose: The aim of the current study was to replicate findings in adults indicating that higher sensitivity to stressful events is predictive of both onset and persistence of psychopathological symptoms in a sample of adolescents and young adults. In addition, we tested the hypothesis that sensitivity to mild stressors in particular is predictive of the developmental course of psychopathology.Methods: We analyzed experience sampling and questionnaire data collected at baseline and one-year follow-up of 445 adolescent and young adult twins and non-twin siblings (age range: 15-34). Linear multilevel regression was used for the replication analyses. To test if affective sensitivity to mild stressors in particular was associated with follow-up symptoms, we used a categorical approach adding variables on affective sensitivity to mild, moderate and severe daily stressors to the model.Results: Linear analyses showed that emotional stress reactivity was not associated with onset (β = .02; P = .56) or persistence (β = −.01; P = .78) of symptoms. There was a significant effect of baseline symptom score (β = .53; P β = .19; P β = .25; P β = −.03; P = .65) or severe (β = −.06; P = .42), stressors was associated with symptom persistence one year later.Discussion: We were unable to replicate previous findings relating stress sensitivity linearly to symptom onset or persistence in a younger sample. Whereas sensitivity to more severe stressors may reflect adaptive coping, high sensitivity to the mildest of daily stressors may indicate an increased risk for psychopathology.

Parkinson’s disease symptoms are most often charted using the MDS-UPDRS. Limitations of this approach include the subjective character of the assessments and a discrepant performance in the clinic compared to the home situation. Continuous monitoring using wearable devices is believed to eventually replace this golden standard, but measurements often lack a parallel ground truth or are only tested in lab settings. To overcome these limitations, this study explores the feasibility of a newly developed Parkinson’s disease monitoring system, which aims to measure Parkinson’s disease symptoms during daily life by combining wearable sensors with an experience sampling method application. Twenty patients with idiopathic Parkinson’s disease participated in this study. During a period of two consecutive weeks, participants had to wear three wearable sensors and had to complete questionnaires at seven semi-random moments per day on their mobile phone. Wearable sensors collected objective movement data, and the questionnaires containing questions about amongst others Parkinson’s disease symptoms served as parallel ground truth. Results showed that participants wore the wearable sensors during 94% of the instructed timeframe and even beyond. Furthermore, questionnaire completion rates were high (79,1%) and participants evaluated the monitoring system positively. A preliminary analysis showed that sensor data could reliably predict subjectively reported OFF moments. These results show that our Parkinson’s disease monitoring system is a feasible method to use in a diverse Parkinson’s disease population for at least a period of two weeks. For longer use, the monitoring system may be too intense and wearing comfort needs to be optimized.

Objective: Childhood trauma (CT) is associated with a range of psychopathologies, including psychosis. However, evidence on underlying mechanisms remains limited. The study aimed to investigate whether CT impacts on youth mental health by modifying sensitivity to stress in daily life.Method: The experience sampling method (ESM) was used to measure momentary stress, negative affect and psychotic experiences in 99 adolescents and young adults (43 help-seeking service users, 16 siblings and 40 controls). Before ESM assessments, CT and depressive, anxiety and psychotic symptoms were assessed.Results: Stress sensitivity, that is, the association between momentary stress and (i) negative affect and (ii) psychotic experiences, was modified by physical and emotional abuse and, partially, emotional and physical neglect, but not sexual abuse in service users and controls. While there was strong evidence for increased stress sensitivity in service users when high vs. low levels of CT were compared, a pattern of resilience was evident in controls, with attenuated, or no differences in, stress sensitivity in those with high vs. low CT levels. Less consistent findings were observed in siblings.Conclusions: Stress sensitivity may be an important risk and resilience mechanism through which CT impacts on mental health in youth.

Objectives: Investigating between-meal snack intake and its associated determinants such as emotions and stress presents challenges because both vary from moment to moment throughout the day. A smartphone application (app), was developed to map momentary between-meal snack intake and its associated determinants in the context of daily life. The aim of this study was to compare energy intake reported with the signal-contingent app and reported with an event-contingent paper and pencil diet diary. Methods: In a counterbalanced, cross-sectional design, adults (N = 46) from the general population reported between-meal snack intake during four consecutive days with the app and four consecutive days with a paper and pencil diet diary. A 10-day interval was applied between the two reporting periods. Multilevel regression analyses were conducted to compare both instruments on reported momentary and daily energy intake from snacks. Results: Results showed no significant difference (B = 11.84, p = .14) in momentary energy intake from snacks between the two instruments. However, a significant difference (B = –105.89, p < .01) was found on energy intake from total daily snack consumption. Conclusions: As at momentary level both instruments were comparable in assessing energy intake, research purposes will largely determine the sampling procedure of choice. When momentary associations across time are the interest of study, a signal-contingent sampling procedure may be a suitable method. Since the compared instruments differed on two main features (i.e. the sampling procedure and the device used) it is difficult to disentangle which instrument was the most accurate in assessing daily energy intake.

Repeated exposures to social exclusion, through a process of sensitization, may result in larger responses to experiences of social stress. The current study tested the hypothesis that healthy Moroccan-Dutch men respond stronger to social stress than Dutch controls 1) in daily life, and 2) in an experimental set-up. A general population sample of 50 Moroccan-Dutch and 50 Dutch young adult males were tested with 1) the Experience Sampling Method, a structured diary technique, assessing reactivity to social stress in daily life, and 2) an experimental exposure to social peer evaluation. No group differences were found in affective or psychotic reactivity to daily social stress. When exposed to a negative social evaluation in the lab, a blunted affective response was found in the Moroccan-Dutch compared to the Dutch group, whereas the psychotic response did not differ significantly between groups. In conclusion, healthy Moroccan-Dutch men are not more sensitive to social stress than healthy Dutch men. Instead, the blunted affective response of Moroccan-Dutch men to peer evaluation may signify habituation rather than sensitization.

BackgroundInterventions based on the experience sampling method (ESM) are ideally suited to provide insight into personal, contextualized affective patterns in the flow of daily life. Recently, we showed that an ESM-intervention focusing on positive affect was associated with a decrease in symptoms in patients with depression. The aim of the present study was to examine whether ESM-intervention increased patient empowerment.MethodsDepressed out-patients (n = 102) receiving psychopharmacological treatment who had participated in a randomized controlled trial with three arms: (i) an experimental group receiving six weeks of ESM self-monitoring combined with weekly feedback sessions, (ii) a pseudo-experimental group participating in six weeks of ESM self-monitoring without feedback, and (iii) a control group (treatment as usual only). Patients were recruited in the Netherlands between January 2010 and February 2012. Self-report empowerment scores were obtained pre- and post-intervention.ResultsThere was an effect of group × assessment period, indicating that the experimental (B = 7.26, P = 0.061, d = 0.44, statistically imprecise) and pseudo-experimental group (B = 11.19, P = 0.003, d = 0.76) increased more in reported empowerment compared to the control group. In the pseudo-experimental group, 29% of the participants showed a statistically reliable increase in empowerment score and 0% reliable decrease compared to 17% reliable increase and 21% reliable decrease in the control group. The experimental group showed 19% reliable increase and 4% reliable decrease.ConclusionsThese findings tentatively suggest that self-monitoring to complement standard antidepressant treatment may increase patients’ feelings of empowerment. Further research is necessary to investigate long-term empowering effects of self-monitoring in combination with person-tailored feedback.

BackgroundCognitive models propose that behavioural responses to voices maintain distress by preventing disconfirmation of negative beliefs about voices. We used Experience Sampling Methodology (ESM) to examine the hypothesized maintenance role of behavioural responses during daily life.MethodThirty-one outpatients with frequent voices completed a smartphone-based ESM questionnaire 10 times a day over 9 days, assessing voice-related distress; resistance and compliance responses to voices; voice characteristics (intensity and negative content); appraisals of voice dominance, uncontrollability and intrusiveness.ResultsIn line with predictions, behavioural responses were associated with voice appraisals (dominance and uncontrollability), but not voice characteristics. Greater resistance and compliance were reported in moments of increased voice distress, but these associations did not persist after controlling for concurrent voice appraisals and characteristics. Voice distress was predicted by appraisals, and, unexpectedly, also by voice characteristics. As predicted, compliance and resistance were related to increases in distress at subsequent timepoints, whilst antecedent voice appraisals and characteristics had no such effect. Compliance, but not resistance, additionally predicted subsequent increases in voice uncontrollability. In both cases, the reverse models showed no association, indicating directional effects of responses on subsequent distress, and of compliance on uncontrollability appraisals.ConclusionsThese results provide support for the cognitive model by suggesting that momentary behavioural and emotional responses to voices are associated with concurrent negative voice appraisals. Findings suggest that behavioural responses may be driven by voice appraisals, rather than directly by distress, and may in turn maintain voice appraisals and associated distress during the course of daily life.