EMA data are collected for a variety of purposes (Bolger et al. 2003).

1. Ebner-Priemer, U.W. Kubiak, T., Pawlik, K. (2009). Ambulatory Assessment.European Psychologist. 14(2). 95–97. • Current psychological research mainly focuses on questionnaires or laboratory studies (Baumeister, Vohs, & Funder, 2007). • Both methods have their advantages and disadvantages. • While questionnaires have proven criterion and conceptual validity for capturing salient personality trait and state variance, they fall short of such validity when variations of actual behavior in real-life settings are sought.

2. Ebner-Priemer, U.W. Kubiak, T., Pawlik, K. (2009). Ambulatory Assessment.European Psychologist. 14(2). 95–97. • Recent criticism of such a questionnaire approach emphasized undue reliance on memory processes that are open to distortions or biases (Kahneman, Krueger, Schkade, Schwarz, & Stone, 2004). • On the other hand, behavior under a controlled laboratory setting may prove unrepresentative if this condition does not match real-life situation characteristics (Fahrenberg, Myrtek, Pawlik, & Perrez, 2007). • Both methodologies appear to lack ecological validity.

3. Ebner-Priemer, U.W. Kubiak, T., Pawlik, K. (2009). Ambulatory Assessment.European Psychologist. 14(2). 95–97. • According to the definition of the Society for Ambulatory Assessment – Understanding Behavior in Context (SAA), ambulatory assessment comprises the use of infield methods to assess the ongoing behavior, physiology, experience, and environmental aspects of humans or nonhuman primates in naturalistic or unconstrained settings. • Ambulatory assessment designates an ecologically relevant assessment perspective that aims at understanding biopsychosocial processes as they naturally unfold in time and in context (see http://www.ambulatory-assessment.org).

4. Shiffman, S., Stone, A.A., Hufford, M.R. (2008). Ecological Momentary Assessment.Annual Review of Clinical Psychology. 4:1–32. • EMA is not a single research method; it encompasses a range of methods and methodological traditions. • EMA draws together several historical traditions, including diaries, self-monitoring, experience sampling, ambulatory monitoring, and others.

5. Ebner-Priemer, U.W. Kubiak, T., Pawlik, K. (2009). Ambulatory Assessment.European Psychologist. 14(2). 95–97. • Ambulatory assessment methodology has the potential to resolve some of these problems, by investigating self-report, physiology, or behavior in (nearly) real-time in everyday life. • Furthermore, ambulatory assessment can help to validate questionnaires and laboratory findings by examining their generalizability to actual behavior in everyday life.

6. Shiffman, S., Stone, A.A., Hufford, M.R. (2008). Ecological Momentary Assessment.Annual Review of Clinical Psychology. 4:1–32 • EMA data are collected for a variety of purposes (Bolger et al. 2003). • We categorize these into four classes: • (a) characterizing individual differences, • (b) describing natural history, • (c) assessing contextual associations, and • (d )documenting temporal sequences.

7. Individual Differences • When used to characterize individual differences, EMA data are aggregated to obtain a measure of the subject that is collapsed across time (i.e., across multiple EMA measures); for example, the average intensity of pain experienced by a pain patient. • As an extension of this, aggregated EMA data might be used to quantify subjects’ characteristics at two different time points; e.g., pain before and after treatment administration.

8. Individual Differences • As estimates of subject characteristics, aggregated EMA data are expected to provide assessments of individuals that are more reliable (because of aggregation) and more valid (because of avoidance of recall bias, representative sampling, and ecological validity). • Of course, if the variable is very stable over time, if recall bias were not present, and if contextual factors did not influence the variable, then there would be no advantage in using EMA.

9. Natural History • To describe natural history, EMA measures are analyzed for trends over time. • In this case, the within-subject variation over time itself is the focus, and time is the independent variable, the X-axis in a graphical representation of the data.

10. Natural History • For example, McCarthy et al. (2006) documented the trajectories of various withdrawal symptoms that smokers experienced after quitting. • The EMA data demonstrated that some symptoms peaked immediately when smokers quit and then decreased over time, while others increased and persisted, and still others increased only gradually over time. • These patterns contradicted widely held notions about the course of the withdrawal syndrome and were associated with differences in treatment outcome.

11. Contextual Associations • Studies that examine contextual associations look at the association or interaction between two (or more) phenomena that co-occur in time. • Analyses of contextual associations are often cross-sectional, even when data are collected longitudinally, in that they examine the co-occurrence of events or experiences, not their sequence. • In these analyses, time is not explicitly represented—it is more of a stage against which the events of interest play out.

12. Contextual Associations • For example, Myin-Germeys et al. (2001) examined emotions accompanying stressful events as a way to test a diathesis-stress model of schizophrenia. • They postulated that vulnerability to schizophrenia would be reflected in excess emotional responses accompanying stress. • Schizophrenics, their first-degree relatives (who are genetically vulnerable), and normal controls were assessed 10 times daily about stressful events and mood.

13. Contextual Associations • An examination of individual differences in average mood showed that the schizophrenics reported more negative affect and more stressful events, whereas vulnerable individuals and normal controls did not differ. • But a look at stressor-mood associations revealed that the first-degree relatives reacted more strongly than did controls. • Thus, examination of the association between stressors and mood at particular moments was key to understanding what vulnerabilities might be conferred by a genetic predisposition to schizophrenia.

14. Contextual Associations • Understanding the momentary crosssectional associations between different aspects of experience has also been important for foundational studies of the structure of behavior and experience; for example, data on the covariation of momentary emotions have been central in the debate about whether positive and negative emotions are polar opposites or are independent dimensions and can be experienced simultaneously. • Feldman-Barrett & Russell (1998) used EMA data to address the argument that although one could be both happy and distressed over some interval of time, in a particular moment, one could be either happy or distressed but not both.

15. Temporal Sequences • Finally, the longitudinal nature of EMA data is used to explicitly examine temporal sequences of events or experiences, to document antecedents or consequences of events or behaviors, or to study cascades of events. • In these analyses, unlike those above, the order of events or assessments is explicitly considered and is a key focus.

16. Temporal Sequences • The previously cited study of quitting smoking (Shiffman et al. 1997b) assessed smokers’ affect and self-efficacy before and after lapses to smoking, and their effects on subsequent progression toward relapse, to test Marlatt’s theory (Curry et al. 1987) that the psychological response to lapses is what drives progression toward relapse. • Comparing assessments obtained before the lapse and afterward confirmed the theory’s hypothesis that lapses would result in increased negative affect and decreased self-efficacy (Shiffman et al. 1997b). • Continued EMA monitoring, however, contradicted the theory’s prediction that increases in negative affect and decreases in self-efficacy would predict the risk of subsequent progression to another lapse or relapse (Shiffman et al. 1996a).

17. Ebner-Priemer, U.W., Trull, T.J. (2009). Ambulatory Assessment. An Innovative and Promising Approach for Clinical Psychology.European Psychologist 14(2):109–119. • Ambulatory assessment offers several advantages for clinical assessment • (a) real-time assessment to circumvent biased recollection and cognitive reconstruction of the past; • (b) assessment in real-life situations to enhance generalizability; • (c) repeated assessment of individuals resulting in a series of assessment data points that can be used to investigate the variability of experience and within-person processes; • (d) multimodal assessment, including psychological, physiological and behavioral data; • (e) the possibility of assessing the context of the report, allowing one to investigate setting- or context-specific relationships; and • (f) the possibility of giving feedback in real time.

18. Real-Time Assessment • Margraf, Taylor, Ehlers, Roth, and Agras (1987) investigated panic attacks in the natural environment using an event-sampling approach in 27 panic attack patients meeting DSM-III criteria and in 19 matched normal controls. • Participants completed the Stanford Panic Attack Diary for 6 consecutive days and were instructed to note whenever a panic attack occurred and what symptoms accompanied it. • Patients reported 175 attacks in total. • Symptom patterns of panic attacks were also obtained by two retrospective assessment methods, namely a disorder specific questionnaire and a structured diagnostic interview.

19. Real-Time Assessment • Interestingly, retrospective data collection methods gave a quite different picture from diary reports. • The main difference was that a greater number of symptoms was endorsed retrospectively. • For example, in the questionnaire, patients reported that the symptom “fear of dying” occurred in 70% of their panic attacks, whereas this symptom was present only in 3% of the panic attacks reported in the diary.

20. Real-Time Assessment • Such a retrospective exaggeration was present for all 13 panic symptoms according to DSM-III. • Averaged over all symptoms, patients reported in the real-time diary a mean occurrence of three panic symptoms, whereas they reported 11 symptoms, on average, in the retrospective questionnaire. • Even though the retrospective methods referred not to the specific panic attacks experienced during the dairy period but to average panic attacks, the differences between cognitive representation of panic attacks and the real characteristics are, indeed, striking.

21. Real-Time Assessment • From a clinical standpoint, it may not be clear which methods should be used to assess symptoms. • Even though ambulatory assessment might be more accurate, it might be more important to know how patients evaluate their symptoms retrospectively, given that panic attacks are short but might be recalled as life long, for example.

22. Real-Time Assessment • However, retrospective self-report measures are not only exaggerated but notoriously context dependent and highly influenced by momentary accessible information. • Consider the mood-congruent memory effect. While in a good mood, a panic patient may have more difficulties remembering negative symptoms of the attack, whereas in a bad or anxious mood the retrieval may be enhanced. • Therefore, the recall of memories is not stable, but highly dependent on current states.

23. Repeated Assessment • One important feature of ambulatory assessment is that variables of interest can be assessed repeatedly in time, resulting in time series that enable researchers to investigate variability of experience and within-person processes. • Clinical disorders that are defined by their instability or cyclic pattern, such as borderline personality disorder (BPD) or bipolar disorder, are, therefore, especially suitable for ambulatory assessment.

24. Repeated Assessment • Ebner-Priemer, Kuo, and colleagues (2007) assessed the affective states of 50 female patients with BPD and 50 female healthy controls every 10 to 20 min during 24 h of their everyday life using electronic diaries. • In contrast to previous paper-and-pencil diary studies, heightened affective instability for both emotional valence and distress was clearly exhibited in the BPD group. • Several authors have confirmed these findings of heightened instability in BPD, at least partially.

25. Repeated Assessment • One of the goals of the ChronoRecord project is the early recognition of the prodromal symptoms of bipolar disorder, which may help to prevent relapses if combined with a patient action plan. • As sleep disturbance is a frequent warning sign of both mania and depression, Bauer and colleagues (2006) collected mood, sleep, and bed rest data from 59 outpatients with bipolar disorder over nearly 6 months. • In a sizable subsample of their patients, the researchers found a significant inverse correlation for sleep and/or bed rest with the change in mood, with a time latency of 1 day. • That is, a sleep loss was followed by a shift toward hypomania/ mania on the next day or a sleep gain was followed by a shift toward depression on the next day. • Even though this correlation was not found in all patients, which might be partly because of rare mania episodes in some patients, this approach appears promising for informing therapeutic interventions and prevention.

26. Repeated Assessment • Zelenski and Larsen (2000) showed evidence that momentary emotions by ambulatory assessment fit better to a discrete model of emotions whereas emotional traits conform better to a dimensional model. • However, most ambulatory assessment studies still rely on dimensional rather than discrete emotion models, which are easier to analyze.

27. Repeated Assessment • When planning a new study using ambulatory assessment, it is imperative to consider the time characteristics of the variables of interest (e.g., how often might these variables change?) in order to provide the best fit between sampling frequency and the construct of interest. • There is a general consensus in the scientific community that the time-based design must fit the temporal dynamics of the processes of interest, but only a handful of studies incorporate these considerations.

28. Repeated Assessment • Repeated measures in ambulatory assessment enable the examination of within-subject relations, such as between everyday life stressors and patients’ affective reactions. • Myin-Germeys, van Os, Schwartz, Stone, and Delespaul (2001) investigated how the affect of persons vulnerable to psychosis shifted when they encountered a stressor in their natural environment, and in what way the emotional reaction to a real-life stressor varied with differing degrees of vulnerability. • They studied 42 patients with psychotic illness, their first-degree relatives (n = 47), and control subjects (n = 49). • An increase in reported stress was associated with an increase in negative affect in all groups.

29. Repeated Assessment • Interestingly, the psychotic-illness group did show the most pronounced reactions in negative affect, whereas the reactions in the first-degree relatives were still heightened compared to the control subjects. • Myin-Germeys and colleagues (2001) concluded that subtle alterations in the way persons interact with their environment may constitute part of the vulnerability for psychotic illness.

30. Multimodal Assessment ofSelf-Report, Physiology, and Behavior • Adding physiological variables to the assessment does provide additional information and reveal a more complete picture of the symptomatology. • However, whether the additional information shows added value, e.g., a better prediction of treatment response, has yet to be shown. • Progress in biosensor technology has lead to compact, portable, and unobtrusive recorder systems that allow naturalistic assessment, whereas sophisticated computer processing enables the control of confounding variables outside the laboratory, like disentangling emotional activation from the activation of physical effort.

31. Multimodal Assessment ofSelf-Report, Physiology, and Behavior • Wilhelm and Roth (1998) investigated 14 flight-phobics and 15 matched controls during a short flight in a 20-seat turboprop airplane. • They assessed a wealth of physiological parameters, derived from cardiovascular, electrodermal, and respiratory activity as well as self-reports of anxiety, tension, excitement, and 13 DSM-III anxiety symptoms. • All subjective measures of anxiety and several physiological measures, including additional heart rate, heart rate, respiratory sinus arrhythmia (RSA), skin conductance fluctuations, and inspiratory pause changed more during the flight in the phobics than in healthy controls (i.e., there was a Group × Time interaction). • In particular, sympathetic activation in phobics exposed to their anxiety-inducing stimuli was enhanced whereas cardiac parasympathetic activation was reduced.

32. Multimodal Assessment ofSelf-Report, Physiology, and Behavior • Discriminant analyses showed excellent group classifications using either self-report or physiological measures. • However, a direct statistical comparison of the effect sizes for heart rate and self-rated anxiety change scores showed that heart rate was significantly poorer in distinguishing groups compared to self-ratings.

33. Multimodal Assessment ofSelf-Report, Physiology, and Behavior • Using structured interviews Albrecht and Porzig (2003) reported memories of heightened physical activity during episodes of distress in patients with BPD. • Ebner-Priemer et al. (2008) tried to replicate this finding, and repeatedly assessed psychological distress and physical activity using a 24 h ambulatory monitoring approach. • Analyses identified no relation between physical activity and distress in either group. • Divergence in findings may be understood when considering that whereas the study of Ebner-Priemer et al. (2008) utilized objective measures of physical activity and real-time data capture, the Albrecht and Porzig (2003) findings are based on recalled subjective information about physical activity.

34. Context-Sensitive Assessment • Symptom questionnaires or interviews, are limited in revealing context sensitive information. • These methods assess symptoms, but rarely the context of the symptoms. • Repeated assessments in ambulatory assessment, however, provide the opportunity to conduct context-sensitive analyses. • An example of a context-sensitive analysis might be the assessments of symptoms in relation to the time of day.

35. Context-Sensitive Assessment • Diurnal variation of mood has been investigated many times in patients with major depressive disorder. • For example, Peeters, Berkhof, Delespaul, Rottenberg, and Nicolson (2006) examined reports of positive affect and negative affect over 6 days (10 prompts per day) from 47 depressed outpatients and 39 healthy individuals. • Relative to healthy individuals, depressed individuals exhibited increasing positive affect levels during the day with a later peak, whereas depressed persons’ negative affect exhibited a more pronounced peak in the morning compared to the healthy individuals.

36. Context-Sensitive Assessment • Another example for context-sensitive assessment is the study of Stiglmayr et al. (2007) in patients with BPD. • According to DSM-IV criteria, dissociative symptoms occur in BPD in response to stress. • To investigate the context-dependent occurrence of dissociative symptoms, the authors assessed dissociative symptoms and subjective ratings of stress every 60 min for 48 h in BPD patients (n = 51), clinical controls (major depression n = 25; panic disorder n =26), and healthy controls (n = 40). • Whereas, in all groups, states of increased stress were paralleled by increased scores of dissociation, the increase in dissociation was more pronounced in BPD patients.

37. Interactivity, Feedback, and Treatment with Ambulatory Assessment Methods • Interactive assessment denotes that the answer given to a current question affects future questions, beeps/prompts, or statements. • Three forms can be distinguished: • (a) interactive ambulatory assessment, • (b) interactive ambulatory assessment with individually tailored moment-specific feedback, and • (c) ambulatory assessment with treatment components.

38. (a) interactive ambulatory assessment • A simple form of interactive ambulatory assessment is branching, mainly used to reduce patients’ assessment burden. • For example, symptoms of panic attacks might be only assessed when a panic attack actually occurred and is endorsed. • Another possibility in interactive ambulatory assessment is to maximize variance by physiology- or context-triggered sampling.

39. (a) interactive ambulatory assessment • A sophisticated algorithm developed by Myrtek (2004), which signals the subject with beeps depending on the subject’s state of physiological arousal to make a self-report. Heart rate and physical activity are measured and compared continuously. • Events with high emotionally induced physiological arousal (heart rate increase without increase in physical activity) and events with low physiological arousal (no heart rate increases) are identified online by an ambulatory physiological recorder-analyzer system. • Detected events trigger a palmtop to beep and to request participants to answer specific questions.

40. (b) interactive ambulatory assessment with individually tailored moment-specific feedback • Not only blurs the distinction between assessment and treatment, but also enables the researcher to study the effects of individually tailored moment-specific feedback. • This online feedback can advise patients how to cope while experiencing symptoms in daily life. • In theory, this would seem to be superior to feedback in a standard treatment setting, which patients receive once a week in a safe, therapeutic environment.

41. (b) interactive ambulatory assessment with individually tailored moment-specific feedback • Using ambulatory assessment, Solzbacher, Böttger, Memmesheimer, Mussgay, and Rüddel (2007) investigated affective dysregulation is patients with chronic posttraumatic stress disorder, bulimia nervosa, and BPD. • Patients rated perceived level of emotions and distress via a cellular phone at four randomly selected times throughout the day for more than 3 weeks. • When patients reported high levels of distress, they automatically received a reminder on how to regulate their distress. • The usefulness of this advice was checked by an additional prompt 30 min later. • The study is ongoing, but the authors have reported encouraging preliminary • findings indicating compliance with the advice.

42. (b) interactive ambulatory assessment with individually tailored moment-specific feedback • Tryon, Tryon, Kazlausky, Gruen, and Swanson (2006) used actigraphy devices with integrated online analysis and feedback features. • They continuously measured motor excess in nine boys with diagnoses of ADHD, combined type. • The boys wore a feedback actigraph during school periods and were reinforced for activity-level reductions. • Most of the participants reduced their activity level from 20 to 47% of baseline levels. Whereas this approach is similar to laboratory-based biofeedback approaches, it differs essentially in that real-life behavior is changed.

43. (c) ambulatory assessment with treatment components • In a randomized, multicenter, international trial, Kenardy et al. (2003) compared a therapist-delivered cognitive-behavioral therapy (CBT) treatment (12 sessions), with a brief 6-session therapist-delivered CBT treatment, a computer-augmented 6-session therapist-delivered CBT treatment, and a wait-list group. • Each treatment condition included about 40 patients. • The palmtop in the computer-augmented CBT treatment signaled the participant five times daily to practice one of the following therapy modules: self-statement, breathing-control, situational exposure, or interoceptive exposure.

44. (c) ambulatory assessment with treatment components • Patients in all treatment conditions showed improvement compared to the wait-list group. • The treatment condition with computer augmentation demonstrated stronger effects regarding several criteria for clinically significant change compared to the brief treatment module alone. • This was, however, only the case at posttreatment, but not at the 6-month follow-up. • The authors also compared treatment costs, which were lowest for the brief treatment and the computer-augmented condition compared to the standard treatment.

45. Fahrenberg, J., Myrtek, M., Pawlik, K., Perrez, M. (2007). Ambulatory Assessment – Monitoring Behavior in Daily Life Settings A Behavioral-Scientific Challenge for Psychology.European Journal of Psychological Assessment. 23(4). 206–213. • We can distinguish between the following sampling strategies and designs of psychological and psychophysiological monitoring and assessment:

46. Fahrenberg, J., Myrtek, M., Pawlik, K., Perrez, M. (2007). Ambulatory Assessment – Monitoring Behavior in Daily Life Settings A Behavioral-Scientific Challenge for Psychology.European Journal of Psychological Assessment. 23(4). 206–213.

47. Fahrenberg, J., Myrtek, M., Pawlik, K., Perrez, M. (2007). Ambulatory Assessment – Monitoring Behavior in Daily Life Settings A Behavioral-Scientific Challenge for Psychology.European Journal of Psychological Assessment. 23(4). 206–213.

48. Fahrenberg, J., Myrtek, M., Pawlik, K., Perrez, M. (2007). Ambulatory Assessment – Monitoring Behavior in Daily Life Settings A Behavioral-Scientific Challenge for Psychology.European Journal of Psychological Assessment. 23(4). 206–213.

49. Wilhelm, P., Schoebi, D. (2007). Assessing Mood in Daily Life Structural Validity, Sensitivity to Change and Reliability of a Short-Scale to Measure Three Basic Dimensions of Mood.European Journal of Psychological Assessment. 23(4). 258–267. • Moods are rather diffuse affective states that subtly affect our experience, cognitions, and behavior. • They operate continuously and “provide the affective background, the emotional color to all that we do” (Davidson, 1994, p. 52). • Moods can be consciously experienced as soon as they gain the focus of our attention, and are then characterized by the predominance of certain subjective feelings.

50. Wilhelm, P., Schoebi, D. (2007). Assessing Mood in Daily Life Structural Validity, Sensitivity to Change and Reliability of a Short-Scale to Measure Three Basic Dimensions of Mood.European Journal of Psychological Assessment. 23(4). 258–267. • Matthews, Jones& Chamberlain (1990) advocated a model in which • valence (V; ranging from unpleasant to pleasant), • calmness (C; ranging from restless/under tension to calm/relaxed), and • energetic arousal (E; ranging from tired/without energy to awake/full of energy) • form the basic dimensions of affects.