Abstract
Ecological momentary assessment (EMA) allows measuring intra-individual processes moment by moment, identifying and modeling, in a naturalistic way, individual levels and changes in different psychological processes. However, active EMA requires a high degree of adherence, as it implies a significant burden for patients. Moreover, there is still no consensus on standardized procedures for implementation. There have been few results in detecting desirable characteristics for the design and implementation of an EMA device. Studies that address these issues from the perspectives of participants in psychotherapeutic processes are needed. To analyze the perspectives of patients, therapists and supervisors on the implementation of an EMA device in a psychotherapeutic treatment for depression. The sample will include eight patients, eleven therapists and five supervisors, taken from a research project that implemented an EMA system for monitoring the dynamics of affectivity at the beginning of psychotherapies for depression. Semi-structured interviews specific to each group are being conducted and analyzed from a qualitative approach based on consensual qualitative research (CQR). Participants reported having a positive evaluation of the study's informational resources and implementation. Difficulties were expressed in responding in the morning hours and the importance of having a customized EMA that is tailored to the needs of the patients was expressed. Furthermore, patients and therapists agreed that the impact of the use of the monitoring system on treatment was neutral or positive. In contrast, patients considered the EMA to be positive for their daily life.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Areas, M., Roussos, A., Hirsch, H., Hirsch, P., Becerra, P., & Gómez-Penedo, J. M. (2018). Evaluación de un dispositivo de investigación orientada por la práctica para el desarrollo de un sistema de feedback en psicoterapia. Revista Argentina De Clinica Psicologica, 27, 229–249. https://doi.org/10.24205/03276716.2018.1064
Baldwin, S. A., & Goldberg, S. B. (2021). Methodological foundations and innovations in quantitative psychotherapy research. In M. Barkham, W. Lutz & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (7th ed., pp. 19–49). Wiley.
Bos, F. M., Snippe, E., Bruggeman, R., Doornbos, B., Wichers, M., & van der Krieke, L. (2020). Recommendations for the use of long-term experience sampling in bipolar disorder care: A qualitative study of patient and clinician experiences. International Journal of Bipolar Disorders. https://doi.org/10.1186/s40345-020-00201-5
Boswell, J. F. (2019). Monitoring processes and outcomes in routine clinical practice: A promising approach to plugging the holes of the practice-based evidence colander. Psychotherapy Research, 30(7), 829–842. https://doi.org/10.1080/10503307.2019.1686192
Castonguay, L. G., Barkham, M., Lutz, W., & McAleavey, A. (2013). Practice-oriented research. In M. J. Lamberts (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 85–133). Wiley.
Castonguay, L. G., Barkham, M., Youn, S., & Page, A. C. (2021). Practice-based evidence—Findings from routine clinical settings. In M. Barkham, W. Lutz & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (50th anniversary edition, pp. 191–222). Wiley.
Castonguay, L. G., & Muran, J. C. (2014). Fostering collaboration between researchers and clinicians through building practice-oriented research: An introduction. Psychotherapy Research, 25(1), 1–5. https://doi.org/10.1080/10503307.2014.966348
Castonguay, L. G., Youn, S. J., Xiao, H., Muran, J. C., & Barber, J. P. (2014). Building clinicians–researchers partnerships: Lessons from diverse natural settings and practice-oriented initiatives. Psychotherapy Research, 25(1), 166–184. https://doi.org/10.1080/10503307.2014.973923
Colombo, D., Suso-Ribera, C., Fernández-Álvarez, J., Cipresso, P., García-Palacios, A., Riva, G., & Botella, C. (2022). Technology-based ecological momentary assessment in clinical psychology. In G. J. G. Asmundson (Ed.), Comprehensive clinical psychology (2nd ed., pp. 106–120). Elsevier.
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science. https://doi.org/10.1186/1748-5908-4-50
Delgadillo, J., & Lutz, W. (2020). A development pathway towards precision mental health care. JAMA Psychiatry, 77(9), 889. https://doi.org/10.1001/jamapsychiatry.2020.1048
Ellison, W. D. (2020). An initial study of practicing psychologists’ views of the utility of ecological momentary assessment for difficult psychotherapy cases. Administration and Policy in Mental Health and Mental Health Services Research, 48(4), 597–607. https://doi.org/10.1007/s10488-020-01093-4
Fernández-Alvarez, H., Gómez, B., & García, F. (2013). Bridging the gap between research and practice in a clinical and training network: Aigle’s Program. Psychotherapy Research, 25(1), 84–94. https://doi.org/10.1080/10503307.2013.856047
Fernández-Álvarez, J., Molinari, G., Szewach, P., Bregman, C., Gómez, B., & Fernández-Álvarez, H. (2022). PATER: An integrative psychotherapy program for socio-economically deprived people in Argentina. Journal of Psychotherapy Integration, 32(1), 95–109. https://doi.org/10.1037/int0000258
Fierro, C., Fernández Álvarez, J., & Manzo, G. A. (2018). A century of psychotherapy in Argentina: Clinical psychology, psychoanalysis and recent developments. Revista De Psicología, 27(2), 1–27. https://doi.org/10.5354/0719-0581.2019.52310
Gómez, B., Fernández-Álvarez, J., & García, F. (2022). Implementing routine outcome monitoring in the treatment of a patient with obsessive–compulsive disorder. Journal of Clinical Psychology, 78(10), 2002–2015. https://doi.org/10.1002/jclp.23418
Gómez-Penedo, J. M., Manubens, R., Areas, M., Fernández-Álvarez, J., Meglio, M., Babl, A., Juan, S., Ronchi, A., Muiños, R., Roussos, A., Lutz, W., & Grosse Holtforth, M. (2023). Implementation of a routine outcome monitoring and feedback system for psychotherapy in Argentina: A pilot study. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2022.1029164
Hall, M., Scherner, P. V., Kreidel, Y., & Rubel, J. A. (2021). A systematic review of momentary assessment designs for mood and anxiety symptoms. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2021.642044
Hasselhorn, K., Ottenstein, C., & Lischetzke, T. (2021). The effects of assessment intensity on participant burden, compliance, within-person variance, and within-person relationships in ambulatory assessment. Behavior Research Methods, 54(4), 1541–1558. https://doi.org/10.3758/s13428-021-01683-6
Hill, C. E., Knox, S., Thompson, B. J., Nutt Williams, E., & Hess, S. A. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52(2), 196–205. https://doi.org/10.1037/0022-0167.52.2.196
Hill, C. E., Thompson, B., & Williams, E. (1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25, 517–572. https://doi.org/10.1177/0011000097254001
Janssens, K. A. M., Bos, E. H., Rosmalen, J. G. M., Wichers, M. C., & Riese, H. (2018). A qualitative approach to guide choices for designing a diary study. BMC Medical Research Methodology. https://doi.org/10.1186/s12874-018-0579-6
Juan, S., Gomez Penedo, J. M., Etchebarne, I., & Roussos, A. J. (2011). El método de investigación cualitativa consensual (consensual qualitative research, CQR): una herramienta para la investigación cualitativa en psicología clínica. Anuario De Investigaciones, XVIII, 47–56.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Lutz, W., De Jong, K., Rubel, J., & Delgadillo, J. (2021). Measuring, predicting, and tracking change in psychotherapy. In M. Barkham, W. Lutz & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (7th ed., pp. 89–134). Wiley.
Lutz, W., Schwartz, B., & Delgadillo, J. (2022). Measurement-based and data-informed psychological therapy. Annual Review of Clinical Psychology, 18(1), 71–98. https://doi.org/10.1146/annurev-clinpsy-071720-014821
Lutz, W., Schwartz, B., Hofmann, S. G., Fisher, A. J., Husen, K., & Rubel, J. A. (2018). Using network analysis for the prediction of treatment dropout in patients with mood and anxiety disorders: A methodological proof-of-concept study. Scientific Reports, 8(1), 7819. https://doi.org/10.1038/s41598-018-25953-0
Marzano, L., Bardill, A., Fields, B., Herd, K., Veale, D., Grey, N., & Moran, P. (2015). The application of mHealth to mental health: Opportunities and challenges. The Lancet Psychiatry, 2(10), 942–948. https://doi.org/10.1016/s2215-0366(15)00268-0
Miller, G. (2012). The smartphone psychology manifesto. Perspectives on Psychological Science, 7(3), 221–237. https://doi.org/10.1177/1745691612441215
Mohr, D. C., Zhang, M., & Schueller, S. M. (2017). Personal sensing: Understanding mental health using ubiquitous sensors and machine learning. Annual Review of Clinical Psychology, 13(1), 23–47. https://doi.org/10.1146/annurev-clinpsy-032816-044949
Ottenstein, C., & Werner, L. (2021). Compliance in ambulatory assessment studies: Investigating study and sample characteristics as predictors. Assessment, 29(8), 1765–1776. https://doi.org/10.1177/10731911211032718
Palmier-Claus, J. E., Rogers, A., Ainsworth, J., Machin, M., Barrowclough, C., Laverty, L., Barkus, E., Kapur, S., Wykes, T., & Lewis, S. W. (2013). Integrating mobile-phone based assessment for psychosis into people’s everyday lives and clinical care: A qualitative study. BMC Psychiatry. https://doi.org/10.1186/1471-244x-13-34
Piot, M., Mestdagh, M., Riese, H., Weermeijer, J., Brouwer, J. M. A., Kuppens, P., Dejonckheere, E., & Bos, F. M. (2022). Practitioner and researcher perspectives on the utility of ecological momentary assessment in mental health care: A survey study. Internet Interventions, 30, 100575. https://doi.org/10.1016/j.invent.2022.100575
Saunders, K. E. A., Bilderbeck, A. C., Panchal, P., Atkinson, L. Z., Geddes, J. R., & Goodwin, G. M. (2017). Experiences of remote mood and activity monitoring in bipolar disorder: A qualitative study. European Psychiatry, 41(1), 115–121. https://doi.org/10.1016/j.eurpsy.2016.11.005
Shiffman, S., Stone, A. A., & Hufford, M. R. (2008). Ecological momentary assessment. Annual Review of Clinical Psychology, 4, 1–32. https://doi.org/10.1146/annurev.clinpsy.3.022806.091415
Skoronski, J. J. (2010). The positive bias and the fading affect bias in autobiographical memory. In M. D. Alicke & C. Sedikides (Eds.), Handbook of self-enhancement and self-protection (p. 524). Guilford Press.
Stone, A. A., Schneider, S., & Smyth, J. M. (2023). Evaluation of pressing issues in ecological momentary assessment. Annual Review of Clinical Psychology, 19(1), 107–131. https://doi.org/10.1146/annurev-clinpsy-080921-083128
Trull, T. J., & Ebner-Priemer, U. W. (2020). Ambulatory assessment in psychopathology research: A review of recommended reporting guidelines and current practices. Journal of Abnormal Psychology, 129(1), 56–63. https://doi.org/10.1037/abn0000473
van de Ven, P., O’Brien, H., Henriques, R., Klein, M., Msetfi, R., Nelson, J., Rocha, A., Ruwaard, J., O’Sullivan, D., & Riper, H. (2017). ULTEMAT: A mobile framework for smart ecological momentary assessments and interventions. Internet Interventions, 9, 74–81. https://doi.org/10.1016/j.invent.2017.07.001
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. https://doi.org/10.1037/0022-3514.54.6.1063
Weermeijer, J., Kiekens, G., Wampers, M., Kuppens, P., & Myin-Germeys, I. (2023). Practitioner perspectives on the use of the experience sampling software in counseling and clinical psychology. Behaviour and Information Technology. https://doi.org/10.1080/0144929x.2023.2178235
Williams, M. T., Lewthwaite, H., Fraysse, F., Gajewska, A., Ignatavicius, J., & Ferrar, K. (2021). Compliance with mobile ecological momentary assessment of self-reported health-related behaviors and psychological constructs in adults: Systematic review and meta-analysis. Journal of Medical Internet Research, 23(3), e17023. https://doi.org/10.2196/17023
Wrzus, C., & Neubauer, A. B. (2022). Ecological momentary assessment: A meta-analysis on designs, samples, and compliance across research fields. Assessment, 30(3), 825–846. https://doi.org/10.1177/10731911211067538
Youn, S. J., Boswell, J. F., Douglas, S., Harris, B. A., Aajmain, S., Arnold, K. T., Creed, T. A., Gutner, C. A., Orengo-Aguayo, R., Oswald, J. M., & Stirman, S. W. (2023). Implementation science and practice-oriented research: Convergence and complementarity. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-023-01296-5
Zapata-Lamana, R., Lalanza, J. F., Losilla, J. M., Parrado, E., & Capdevila, L. (2020). mHealth technology for ecological momentary assessment in physical activity research: A systematic review. PeerJ, 8, e8848. https://doi.org/10.7717/peerj.8848
Acknowledgements
This work was supported by the Margarita Salas Postdoctoral Contract MGS/2021/37 (UP2021-021) financed by the European Union-NextGenerationEU.
Funding
The research project in which this study is part of was funded by the Secretariat of Science and Technology of the University of Buenos Aires (UBA), in the framework of a Grant of “Proyectos de Desarrollo Estratégico [Strategic Development Projects]” in 2021, under the title “Implementación de un sistema de evaluación ecológica para monitoreo de las dinámicas de afectividad al principio de tratamientos psicoterapéuticos para la depresión [Implementation of an ecological evaluation system for monitoring the dynamics of affectivity at the beginning of psychotherapeutic treatments for depression]” directed by Dr. Roberto Muiños. The present qualitative research has been pre-registered on the Open Science Framework (OSF) website on 17 July 2022 (https://osf.io/r8xew/?view_only=278cd88585294158807ce21b5762cc8c).
Standards of ReportingThe reporting guidelines of O'Brien et al. (2014) were followed for the current study:
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research. Academic Medicine, 89(9), 1245–1251. https://doi.org/10.1097/acm.0000000000000388.
Author information
Authors and Affiliations
Contributions
Contributions to the conception and design of the study were made by Juan Martín Gómez Penedo, Roberto Muiños, Andrés J. Roussos, Javier Fernández-Álvarez, Fernando García and Beatríz Gómez. Sofia Marasas and Manuel Meglio were in charge of coordinating the implementation and data collection of the original study. Sofia Marasas and Manuel Meglio were in charge of creating the questionnaires for each type of participant for the current study. The training of the study interviewers was carried out by Fernando Garcia, Sofia Marasas and Manuel Meglio. Contact with the study participants was in the hands of Fernando García and Beatríz Gómez. Data collection through interviews was carried out by Julio Montedoro, Antonio Nicolás Jáuregui, Claudia Castañeiras and Pablo Santagnelo. Regarding the data analysis, Santiago Juan was responsible for the training and follow-up of the process. Then, the data analysis was carried out by Manuel Meglio, Rocío Manubens, Julio Montedoro and Antonio Nicolás Jáuregui. Finally, the first draft of the manuscript was written by Manuel Meglio and Rocío Manubens. Javier Fernández-Álvarez critically reviewed and commented on the manuscript for important intellectual content. All authors commented on earlier versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors whose names appear as authors of this manuscript certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.
Ethical Approval
All procedures performed in this study were approved by the Ethics Committee of the University of Buenos Aires. Furthermore, they conformed to the principles of the 1964 Declaration of Helsinki and its subsequent modifications or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual patients included in the original study. Then, for the current study, verbal informed consent was obtained from all participants before each of the interviews.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Meglio, M., Manubens, R.T., Fernández-Álvarez, J. et al. Implementation of an Ecological Momentary Assessment (EMA) in Naturalistic Psychotherapy Settings: Qualitative Insights from Patients, Therapists, and Supervisors Perspectives. Adm Policy Ment Health (2024). https://doi.org/10.1007/s10488-024-01362-6
Accepted:
Published:
DOI: https://doi.org/10.1007/s10488-024-01362-6