When Hindsight Is Not 20/20: Ecological Momentary Assessment of PTSD Symptoms Versus Retrospective Report

Abstract

Assessment of posttraumatic stress disorder (PTSD) has relied almost exclusively on retrospective memory of symptoms, sometimes over long intervals. This approach creates potential for recall bias and obscures the extent to which symptoms fluctuate. The aim of the present study was to examine the discrepancy between retrospective self-reporting of PTSD symptoms and ecological momentary assessment (EMA), which captures symptoms closer to when they occur. The study also sought to estimate the degree to which PTSD symptoms vary or are stable in the short-term. World Trade Center responders ( N = 202) oversampled for current PTSD (19.3% met criteria in past month) were assessed three times a day for 7 consecutive days. Retrospective assessment of past week symptoms at the end of the reporting period were compared with daily EMA reports. There was correspondence between two approaches, but retrospective reports most closely reflected symptom severity on the worst day of the reporting period rather than average severity across the week. Symptoms varied significantly, even within the span of hours. Findings support intervention research efforts focused on exploiting significant, short-term variability of PTSD symptoms, and suggest that traditional assessments most reflect the worst day of symptoms over a given period of recall.

A Systematic Review of Momentary Assessment Designs for Mood and Anxiety Symptoms

“…It may be easier to identify whether more concrete occurrences happened within a specific timeframe (e.g., Within the last 3 h, I interacted with a family member) compared to more subtle experiences which may be better measured over the course of a whole day (e.g., How melancholic did you feel today?). Interestingly, a study by Schuler et al (2019) found no significant differences between the retrospective reports of symptoms when compared to EMA-based reports of traumatic experiences. These findings may reflect the unique circumstances involved in recall of such experiences, which are inherently more emotionally extreme and may therefore be easier to recall, even retrospectively.…”

Invisible Hands and Fine Calipers: A Call to Use Formal Theory as a Toolkit for Theory Construction

“…A weighted average that favors the moments immediately before the assessment? Or, as some research suggests, will their responses reflect the most intense perceived threat they experienced over the time window (Schuler et al, 2021)? Similar questions arise in our examination of mate-selection strategies.…”

A Review of Explicit and Implicit Assumptions When Providing Personalized Feedback Based on EMA Data.

“…These drawbacks of EMA can be alleviated by asking participants about experiences since the last measurement occasion (c.f., Ben-Zeev et al, 2012;van Roekel et al, 2017;Fernandez, Fisher, & Chi, 2017;Rinner et al, 2019), or since some time index (c.f., Gloster et al, 2008;Priebe et al, 2013;Schuler et al, 2019). In this approach, participants are essentially required to recall and aggregate over some limited time interval.…”

“…In addition to affective experiences, a comparison between ERA and RA is typically used in the symptom domain, likely because ERA is better able to capture salient experiences in comparison to EMA. For symptoms, the results are much more diffuse, with some authors reporting higher RA scores for panic attacks (De Beurs, Lange & Dijck, 1992), alcohol use (Simpson et al, 2011) 12 , psychotic experiences (Ben-Zeev et al, 2012), PTSD symptoms (Campbell et al, 2017;Schuler et al, 2019), and social phobia (Rinner et al, 2019), while others have found relatively good congruence for OCD (Gloster et al, 2008) and PTSD (Naragon-Gainey et al, 2012) symptomatology. Mixed results have been reported for bulimia nervosa (Stein & Corte, 2003;Wonderlich et al, 2015) and borderline personality disorder (Solhan, Trull, Jahng & Wood, 2009;Mneimne et al, 2019) symptoms.…”