Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on the dynamics of behavior in real-world settings.

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Ecological Momentary Assessment (EMA) is particularly suitable for studying substance use, because use is episodic and thought to be related to mood and context. This paper reviews EMA methods in substance use research, focusing on tobacco and alcohol use and relapse, where EMA has most been applied. Common EMA designs combine event-based reports of substance use with time-based assessments. Approaches to data organization and analysis have been very diverse, particularly regarding their treatment of time. Compliance with signaled assessments is often high. Compliance with recording of substance use appears good, but is harder to validate. Treatment applications of EMA are emerging. EMA captures substance use patterns not measured by questionnaires or retrospective data, and hold promise for substance use research.

Self-report data are ubiquitous in behavioral and medical research. Retrospective assessment strategies are prone to recall bias and distortion. New techniques for assessing immediate experiences in respondents' natural environments (e.g., Ecological Momentary Assessment, Experience Sampling) are being used by many researchers to reduce reporting bias. This article discusses seven aspects of momentary research that are often overlooked or minimized in the presentation of momentary research reports, yet that are critical to the success of the research: (a) the rationale for the momentary sampling design, (b) the details of momentary sampling procedures, (c) the data acquisition interface, (d) rates of compliance with the sampling plan, (e) the procedures used to train and monitor participants, (f) data management procedures, and (g) the data analytic approach. Attention to these areas in both the design and reporting of momentary research studies will not only improve momentary research protocols but also allow for the successful replication of research findings by other investigators.

Doctors often ask patients to recall recent health experiences, such as pain, fatigue, and quality of life. 1 Research has shown, however, that recall is unreliable and rife with inaccuracies and biases.2 Recognition of recall's shortcomings has led to the use of diaries, which are intended to capture experiences close to the time of occurrence, thus limiting recall bias and producing more accurate data. 3The rationale for using diaries would be undermined if patients failed to complete diaries according to protocol. In this study we used a newly developed paper diary that could objectively record when patients made diary entries in order to compare patients' reported and actual compliance with diary keeping. For comparison, we also used an electronic diary designed to enhance compliance in order to assess what compliance rates might be achieved. Methods and resultsWe recruited 80 adults with chronic pain (pain for >3 hours a day and rated >4 on a 10 point scale) and assigned 40 to keeping a paper diary and 40 to an electronic diary. On satisfying the eligibility criteria, each patient was assigned to the next training session for which he or she was available, regardless of which diary it was for. We conducted one training session for each diary each week, with each training session for the paper diary matched by time and day of the week with an electronic diary training session. Participants were paid $150 and gave their informed consent; patients given the paper diary were not told that compliance would be recorded electronically.The paper diary comprised diary cards bound into a DayRunner Organizer binder. The cards contained 20 questions drawn from several common pain instruments and included fields to record time and date of completion. The diary binders were unobtrusively fitted with photosensors that detected light and recorded when the binder was opened and closed; these were extensively tested and validated. The electronic diary was a Palm computer with software for data collection in clinical trials and presented identical pain questions via a touch screen and recorded time and date of entries. This system (invivodata) incorporated several features to maximise compliance, including auditory prompts, and has demonstrated good compliance. 4 Patients were instructed to complete daily entries at 10 am, 4 pm, and 8 pm within 15 minutes of the target times. With the electronic diary, entries could not be initiated outside the designated 30 minute windows. We considered paper diary entries to be compliant if they were made within the 30 minute windows. A more liberal secondary outcome allowed a 90 minute window around the target times. Reported compliance was based on the time and date that patients recorded on their paper diary cards. Actual compliance was based on the electronic record (from the record of diary binder openings for paper diaries). Paper diary entries were deemed compliant if the binder was opened or closed at any point during the target time window. We also assessed "hoarding" with the pape...

We report the development of a new multidimensional questionnaire to measure nicotine dependence, based on Edwards's syndromal conceptualization of dependence. We present three studies. In study 1, we administered the Nicotine Dependence Syndrome Scale (NDSS) to 317 smokers in a smoking cessation study. Factor analysis of the NDSS revealed five factors: Drive (craving and withdrawal, and subjective compulsion to smoke), priority (preference for smoking over other reinforcers), tolerance (reduced sensitivity to the effects of smoking), continuity (regularity of smoking rate), and stereotypy (invariance of smoking). A single overall score based on the first principal component, NDSS-T, was retained as a single core measure of dependence. The NDSS showed promising psychometric properties: NDSS-T and factor scores showed strong associations with dependence-relevant measures, even when we controlled for scores on the Fagerström Tolerance Questionnaire (FTQ); and the NDSS predicted urges when smoking, withdrawal in acute abstinence, and outcome in cessation. The five factor scores showed differential patterns of correlations with external validators, supporting the multidimensionality of the measure. In study 2, we revised the NDSS to expand some subscales and administered it to 802 smokers in a cessation study. The same five factors were extracted, the internal reliability of some subscales was improved, and the factor scores again showed associations with dependence-relevant validators, which were largely maintained when we controlled for FTQ scores. In study 3, with 91 smokers in a cessation trial, we established that the test-retest reliability of the subscales was adequate. Thus, the NDSS presents a valid multidimensional assessment of nicotine dependence that may expand on current measures.

Extensive evidence indicates that paper- and computer-administered PROs are equivalent.

Objective This paper presents an experimental design, the micro-randomized trial, developed to support optimization of just-in-time adaptive interventions (JITAIs). JITAIs are mHealth technologies that aim to deliver the right intervention components at the right times and locations to optimally support individuals’ health behaviors. Micro-randomized trials offer a way to optimize such interventions by enabling modeling of causal effects and time-varying effect moderation for individual intervention components within a JITAI. Methods The paper describes the micro-randomized trial design, enumerates research questions that this experimental design can help answer, and provides an overview of the data analyses that can be used to assess the causal effects of studied intervention components and investigate time-varying moderation of those effects. Results Micro-randomized trials enable causal modeling of proximal effects of the randomized intervention components and assessment of time-varying moderation of those effects. Conclusions Micro-randomized trials can help researchers understand whether their interventions are having intended effects, when and for whom they are effective, and what factors moderate the interventions’ effects, enabling creation of more effective JITAIs.