# List of EMA EMI Systems #hope-s Reference [[20211120 All about EMA and EMI]] [[How do they measure Acceptability and Usability]] [[How do they measure feasibility]] [[How do they measure efficacy]] [[Schizophrenia]] ## Motivation and Skills Support (MASS) app [[Article - Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia - Pre-Post Study of the Motivation and Skills Support App]] A social functioning intervention app. 31 patients went through the interventions, self report social functioning increased but effect not sustained at 3 months follow up. # SAVVy [[Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy)]] - An blended approach, use of EMA/EMI and Clinician to remind patients their coping strategies, to remind them ways to manage voices. - Shows to be effective. ## FOCUS system ^c674e5 [[FOCUS - Ben Zeev, Brenner, Begale, Mueser]] 1. 1. Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin  (FOCUS) [[ACTISSIST from UK]] (CBT app for schizophrenia) EMA - 3 times a day - 6 days per week - for 12 weeks - from 10-10pm. - To remind user to use the app. EMI - Questions - Answer Format - Then give normalising message - Then cognitive and behavioural suggestions Features / Resources 1. Relaxation 2. Mindfulness 3. Audio/Video of peer recovery stories 4. Diary 5. Information facts 6. Link to website like TED talk 7. Past 7 days data summary 8. Can customised UI wallpaper using their own images **ClinTouch** - 3 Times a day - 6 days a week - 10-10pm - 12 weeks EMA - 10-18 Symptoms statements. Patient make degree of agree/disagree - Can snooze once. **TechCare** - [[Care Co-Ordinator in my Pocket. A feasibility study of mobile assessment and therapy for psychosis - TechCare]] - [[TechCare - mobile assessment and therapy for psychosis - an intervention for clients in the Early Intervention Service - A feasibility study protocol]] **ReMindCare** [[ReMindCare, an app for daily clinical practice in patients with first episode psychosis - A pragmatic real-world study protocol]] [[Bipolar Disorder]] ## Personalized Real-Time Intervention for Stabilizing Mood PRISM ^9f8ed9 https://drive.google.com/file/d/1_5OCuHbBWabPfACFtemVNmU8ipwU9fjU/view Participants respond to questions about their mood state and illness triggers, similar a ‘mood chart’ frequently employed in interventions for bipolar disorders(Miklowitz, 2008; Scott et al, 2005). When participants signal that they are experiencing an exacerbation in symptoms or an illness trigger, a pre-selected self-management strategy appears on the PDA screen. For example, when the participant indicates they are “mildly depressed”, the next screen presents them with the personally assigned adaptive strategy to that mood severity and polarity (e.g., “if you take the dog for a walk, you usually feel less depressed”). In this manner, participants’ personalized adaptive strategies and early warning signs coupled with real-time assessment of clinical state. ^f010a6 ![[Augmenting Psychoeducation with a Mobile Intervention for Bipolar Disorder A Randomized Controlled Trial#^5078b3]] - Related [[Augmenting Psychoeducation with a Mobile Intervention for Bipolar Disorder A Randomized Controlled Trial]] ## Mobile Assessment and Therapy for Schizophrenia (MATS) ^8507f8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329971/ Design—MATS uses automated text messaging on a mobile phone to obtain consumer reported data on psychotic symptom severity, social interactions, and medication adherence in individuals with psychotic disorders. These data are uploaded to a central server enabling consumers’ providers on Assertive Community Treatment (ACT) teams to view consumers’ data in real time. Email reports, including graphs of ratings in each of these domains, are also sent to ACT staff each Friday. The goal of feeding back these consumer reports is to enable ACT staff to remotely monitor their caseload, prioritize services, and enhance their capacity to prevent relapses. ACT is a team-based approach, customized to each consumer, in which staff is available 24 hours a day, with a primary goal of avoiding hospitalization and improving community functioning (Marshall et al, 2000). For ACT staff, the potential benefits of mobile monitoring would be in enabling better management of caseloads, more rapid relapse prevention, and effective intensive case management of severely ill frequent service users on ACT teams. Potential motivators for mental health administrators of mobile monitoring would include cost and productivity benefits (e.g., avoiding check-in visits when consumers report they are doing well), and a more efficient method of meeting mandated outcomes measurement goals (e.g., functioning, quality of life, service use). Additionally, MATS may reduce the amount of staff and clinician time required to gather consumer data for ongoing outcomes assessment. ### Design of MATS ^b83479 Three sets of 4 text messages (12 total) were sent to participants each day, Monday through Saturday, with each message set targeting 1 of the **3 intervention domains**: ** #medication_adherence, #socialization, or #auditory_hallucinations**. All 3 interventions were delivered in random order each day in the morning, afternoon, and evening. The number and frequency of text messages were based, in part, on focus group feedback and the amount of time needed to send and respond to text messages. Our goal was to adequately sample daily behavior and intervene frequently enough to have a potential impact on the target outcomes, without overburdening individuals with time-consuming messages. Focus group feedback was that more frequent messaging, especially for a 3-month period might be too much. To accommodate daily routines, participants were allowed to choose the specific times they would receive messages within a 2-hour window. Each time a text message was received, the phone generated an auditory signal and/or a vibration that prompted participants to read the message. The **text-messaging interventions incorporated #CBT techniques**.[19](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329971/#bib19),[20](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329971/#bib20) Thoughts about medications, socializing, and voices were elicited (eg, “Do you think your voices are powerful?”), and the next messages encouraged participants to question unhelpful beliefs (eg, “Maybe your voices can’t really do what they say”) and try a behavioral experiment (eg, “Try ignoring them and see what happens”). Evidence used to challenge unhelpful beliefs included personalized information provided by the participant. During a baseline interview, the rater who performed the research assessments asked a standard set of questions to elicit personalized information to be used in the text messages. Participants were asked to report at least one benefit of medications and socializing, and a coping strategy that reduced the frequency or distress related to voices (eg, “What is a benefit or something good about taking your medication?”; “What is something you like to do for fun with other people?”; “What do you do to help cope with voices?”). This information was used to create personalized thought-challenging messages. For medication adherence, the messages were “But you said taking meds helped you (personal reported benefit from taking medications).” For social functioning, the message was, “But you said that (personal enjoyable social activity) was fun.” For auditory hallucinations, the message was “You said that (personalized effective coping strategy) helps.” The individualized text messages were entered into a secure website, which could only be accessed by research staff. Once the content was entered, the interventions were sent automatically by a remote secure server. ](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=3329971_schbulsbr155f01_lw.jpg) [[ ](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=3329971_schbulsbr155f03_lw.jpg) ](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=3329971_schbulsbr155f02_lw.jpg) ## Skills Training and Empowerment Program (STEP) Mean Age 46.5 Design—STEP uses live therapist interaction to increase homework compliance in skills training for schizophrenia. STEP builds from [[Functional Adaptations and Skills Training (FAST)]], which is a 24-week intensive intervention aimed at increasing everyday living and social skills in middle-aged and older people with schizophrenia. In an RCT with 240 participants who were randomized to FAST or a time-equivalent attention control condition, FAST was associated with improvement performance-based measures of functioning (Patterson et al, 2003; Patterson et al, 2006). Despite these positive findings, the median number of sessions attended was 13 out of 24, and approximately 20% of participants attended fewer than 5 sessions. STEP was designed to reduce the number of sessions of FAST as well as to enhance the utilization of skills in the naturalistic environment. ## The efficacy of SMS text messages to compensate for the effects of cognitive impairments in schizophrenia https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1348/014466509X467828 [[The efficacy of SMS text messages to compensate for the effects of cognitive impairments in schizophrenia.pdf]] Sixty-two people with schizophrenia or related psychotic disorders were included in the study. All patients showed impaired goal-directed behaviour in daily life-situations. Patients were prompted with SMS text messages to improve their everyday functioning. The primary outcome measure was the percentage of goals achieved. No mention what kind of messages sent. ## ITAREPS IQ The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) programme ^18f01a ITAREPS IQ: Module for sophisticated prediction of schizophrenia relapses https://www.researchgate.net/publication/253644454_ITAREPS_IQ_Module_for_sophisticated_prediction_of_schizophrenia_relapses https://core.ac.uk/reader/47182514 The ITAREPS system is generally based on early warning signs questionnaires. There are a couple of different early warning signs questionnaires (EWSQs) described in recent literature [5], [7], [9]. ^dd3727 The patient concerned in ITAREPS system responds ten questions included in patient's questionnaire, for example "Does your feeling of being laughed or talked about changed for the worse during this week?" The observer - family member or person close to patient - answers similar questions about patient's mental health. Both the patient and the observer evaluate any change for the worse of particular items by numbers between 0 and 4 and send responses via mobile phone message. 0 - no change or improvement 1 - mild worsening 2 - intermediate worsening 3 - severe worsening 4 - extreme worsening Patients and their family informants are asked to send mobile phone message once a week. When a total score i.e. sum of all answers in patient's message, exceeds given value, the ITAREPS sends alert to outpatient psychiatrist and the medication is increased. Patient is asked to perform the evaluation twice a week in five weeks following after alert state. If during three weeks no alert state arises, the medication is decreased and patient sends his messages once a week again. The key point is timely intervention: to contact patient as soon as possible and; based on telephone interview; to temporally increase medication as described previously. The psychiatrist needs very short time to register to the system. After psychiatrist’s login the individual page with list of patient coded under differs numbers appeared. - Good idea but not conclusive. Participation, and not enough data Developed by the Prague Psychiatric Centre in the Czech Republic, ([1](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680266/#b1)) ## Mobus Mobus: 6-week intervention. Patients program personalized goals and are then prompted to complete these at appropriate times. Patients’ record completed activities and symptoms, and this information is sent to caregivers. Ecological Assessments of Activities of Daily Living and Personal Experiences with Mobus, An Assistive Technology for Cognition: A Pilot Study in Schizophrenia https://www.tandfonline.com/doi/abs/10.1080/10400435.2012.659324 Gave them a PDA, with schedules. To remind patient to do their ADL activities. "Tap" when they have done it. Or tap symptoms if they experience symptoms. --- [[Use of Ecological Momentary Assessment and Intervention in Treatment With Adults]] [[Anxiety]] and [[Depression]] **The Worry Outcome Journal** ^f2661a The Worry Outcome Journal asks participants to write about their worries on paper when prompted by text messages several times per day for 10 days (16). In a randomized trial of the Worry Outcome Journal, participants logged the content of their worry at that particular moment in time and answered a series of questions related to the degree of distress, the amount of time spent thinking about that particular worry, how likely they felt it was that the feared outcome would happen, and how likely it was that “a person would logically conclude the worried outcome would occur if they were thinking as realistically as possible” (16, p. 832). At postintervention, the Worry Outcome Journal was more effective than the control condition, which asked participants to use a “thought log” that tracked general thoughts (not specific to worry) and did not prompt analysis of the content of the thoughts. A marginally significant advantage for the Worry Outcome Journal was maintained at the 20-day follow-up. Results suggest that EMI may be used effectively to record and also challenge anxious thoughts. Furthermore, the high rate of completed prompts (all participants in the study completed at least 80%) may suggest that novel aspects of EMI can be useful even with highly anxious clients who might otherwise allow their worry to interfere with self-initiated homework completion. **The Stress Manager** EMI has also been used in a computer-assisted group therapy treatment for generalized anxiety disorder (17). This intervention used software called the Stress Manager. The Stress Manager collected baseline information from the re- spondent for a two-week period, prompting the client five times during each day. After this baseline period, partici- pants initiated in-person group therapy, and the Stress Manager app prompted them with material relevant to the content of the intervention. This computer-assisted version of the therapy took place over six weeks and was com- pared with six- and 12-week versions of in-person cognitive- behavioral group therapy without computer assistance. ^e77b8d The computer-assisted intervention showed a statistically significant advantage over the six-week in-person therapy at posttreatment and was equivalent (as predicted) to the 12-week in-person therapy at posttreatment. Although the finding was not statistically significant, the authors pointed out that the group receiving the computer-assisted six-week treatment showed a larger proportion of participants dem- onstrating reliable change across all follow-up points, rela- tive to the two comparison conditions. The authors of the study suggested that posttreatment benefits might have been the result of increased homework compliance (as a result of mobile prompts), increased generalizability of treatment (because of in-the-moment instructions), or an increased sense of safety (not otherwise provided by paper handouts). Panic Disorder Kenardy and colleagues (18) compared different delivery methods of cognitive-behavioral therapy (CBT) for panic disorder. Six sessions of CBT plus a computer- assisted momentary support were compared with six ses- sions of CBT without the computer, 12 sessions of CBT without the computer, and a wait-list group. The computer assistance included five daily alarm signals on a handheld electronic device referred to as a “personal digital assistant,” which prompted participants to complete self-statements, practice breathing control, and engage in exposure activities. Although all treatment conditions were significantly better than the wait-list condition, there were no differences be- tween the computer-assisted six-session CBT therapy and the noncomputer-assisted therapy sessions. Depression **Delivering CBT elements via app.** ![[An overview of and recommendations for more accessible digital mental health services#^6d9886]] Several EMI approaches have been developed to target depression and to incorporate EMI into CBT (20) as well as acceptance and commitment therapy (21). The most common approach has been to include CBT elements of self- monitoring and behavioral activation in an EMI delivery format. Generally, as reviewed by Schueller et al. (14), EMIs for depression show small to medium effects within partic- ipants on depressive symptoms. One unique approach by Burns et al. (20) followed eight participants who utilized a program that used GPS, ambient light, recent calls, and several other functions to predict mood, emotions, motivational states, activities, and environ- mental context. This information was incorporated into a feedback graph that the participant could review and that provided tools to teach patients rudimentary behavioral activation concepts. Study clinicians provided telephone calls and e-mails to participants to maintain program adherence. Results from this small open trial showed that self- reported depressive symptoms significantly improved over eight weeks of use. This suggests that when used in conjunction with a therapist or provider, EMI is feasible, functionally reliable, and acceptable among patients with depression. Future research to determine its efficacy compared with other treatment interventions is needed. [[202201271457 EMI need to link with a human support]] **Bipolar Disorder** With respect to bipolar disorder, EMI has been used to reduce depressive symptoms (22) and to increase medi- cation adherence (23). Depp and colleagues (22) compared 10 weeks of paper-and-pencil mood monitoring with an EMI treatment that included personalized coping strate- gies among 82 individuals diagnosed with bipolar disorder. Those who were in the EMI condition showed significant reductions in depressive symptoms in the short term com- pared with participants in the control condition, although these gains were no longer evident by 24 weeks. There were also no differences at any time point between groups in terms of manic symptoms or functional impairment. Wenze and colleagues (23) conducted an uncontrolled pilot study of an EMI to promote medication adherence over a two-week period. They found evidence of feasibility and acceptability as well as efficacy for medication adherence and depressive symptoms in their sample of 14 individuals with bipolar disorder. Thus, research on EMI for bipolar disorder suggest that EMI is feasible and acceptable. How- ever, preliminary evidence may hint that EMI is better suited to managing medication adherence and symptoms of de- pression than it is to improving symptoms of mania. Still, efficacy trials are needed to answer more fine-tuned ques- tions of when and for whom EMI is most efficacious among those with bipolar disorder. Taken together, findings from the literature investigating EMI as an adjunctive or stand-alone treatment for anxiety and mood disorders are promising but currently limited. Although most research suggests that EMI combined with other forms of in-person therapy is feasible, acceptable, and effective, it is uncertain whether EMI provides a clear advantage over other forms of treatment when deployed in its current form. There is a dearth of literature exploring mechanisms of EMI or dismantling specific components’ efficacy, and the questions of how, for whom, and when to use EMI are still widely unanswered. The current body of research provides a strong foundation for understanding EMI as a potentially therapeutic resource for anxiety and depression, but more rigorous research investigating its comparative efficacy is needed in the next several years. [[smoking cessation]] Participants in one such program, Happy Ending, found significantly higher repeated point abstinence rates than participants who were given a self-help book (32). Therefore, developers of smoking-based EMI programs may find benefit in combining several different tools from which clients may choose on the basis of their individual needs. [[Use of Ecological Momentary Assessment and Intervention in Treatment With Adults]] [[Physical Activity]] **iPromptU** Cognitive Behavioral Institute of Albuquerque offers a free app called iPromptU to deliver content consistent with CBT, including homework and self-monitoring. This material may be personalized by the therapist, and the app may also be used for EMA. There are no published empirical reports supporting the use of this app; however, it is customizable and could be used to incorporate some of the features of effective EMA and EMI apps. [[Use of Ecological Momentary Assessment and Intervention in Treatment With Adults]] --- [[Daily mood monitoring of symptoms using smartphones in bipolar disorder - A pilot study]] - 4 Scaling questions to survey Mood, Energy, Speed of thought, Impulsivity for Mood disorder patients - Social stress question -