JMIR Publications

ABSTRACT

Background:

Ecological momentary interventions (EMIs) offer a promising strategy for targeting putative mechanisms of mental health problems by delivering real-time, tailored intervention components that adapt to person, moment, and context based on data collected using ecological momentary assessment (EMA). However, most research to date focuses on effects on distal outcomes, at the person level, whereas explorations of processes at the micro-level, i.e., proximal effects of EMI components on putative momentary mechanisms and outcomes, remains very limited.

Objective:

This study aimed to explore the proximal effects of completing EMI components on momentary mental health mechanisms and outcomes (i.e., negative affect, stress, stress reactivity) at the subsequent EMA among youth with early mental health problems.

Methods:

EMIcompass is a novel, transdiagnostic, compassion-focused EMI for prevention and early intervention of severe mental health conditions in help-seeking youth. Data were derived from the experimental condition of the EMIcompass exploratory randomized controlled trial, in which youth aged 14-25 with early mental health problems were randomly allocated to intervention + TAU (experimental condition) or TAU only (control condition).

Results:

We found some evidence of proximal effects of EMI interactive task completion on greater reductions in negative affect, stress, and stress reactivity in a small subsample of n=37 participants. The effect sizes of within-subject reductions in momentary negative affect (β = 0.13, z =1.36, 95% CI = −0.06 to 0.31, d = 0.14, stress (β = 0.19, z = 1.44, 95% CI = −0.07 to 0.44, d = 0.14), and stress reactivity (β = 0.15, z = 1.15, 95% CI = -0.11 – 0.42, d = 0.12) were small to moderate but 95% CIs included zero. Further exploratory analyses suggested greater reductions in momentary negative affect for some types of EMI exercises, i.e. “breathing exercises” (β = 0.39, z = 2.12, 95% CI = 0.03 – 0.75, d = 0.36) and “soothing imagery” (β = 0.24, z = 1.27, 95% CI = -0.13 – 0.61, d = 0.22) but not others.

Conclusions:

Our findings illustrate the feasibility of investigating micro-level processes within an EMI framework, but remain equivocal with regard to proximal effects, owing to limited power in this small sample. Further research with larger samples and appropriate study designs is needed to clarify how EMI components impact momentary mental health mechanisms and outcomes. Clinical Trial: This study uses data from the EMIcompass exploratory RCT that was registered in the German Clinical Trials Register (DRKS00017265).