# Ecological Momentary Assessment. Saul Shiffman, Arthur A. Stone, and Michael R. Hufford #EMA [[Ecological Momentary Assessment.pdf]] **Diagnosis of psychopathology are based on functional impairments expressed in real-world settings yet behavior are seldom studied, assessed or observed in real world. Usually done by interviews, self-reporting.** - _Clinical psychologists, along with behavioral, social, and health scientists and practitioners of every stripe, are interested in people’s ev- eryday real-world behavior. This interest is perhaps especially marked for clinical psy- chologists because psychopathology and its functional impairments are expressed in real world settings: No one is diagnosed or treated because of how they behave in a laboratory or consulting room. Yet, behavior is seldom studied, assessed, or observed as it unfolds in the real world. Instead, both clinicians and re- searchers rely on global, summary, or retro- spective self-reports of behavior_ [[202111211107 Diagnosis of psychopathology are based on functional impairments expressed in real-world settings]] ^2119c3 **Asking patient to recall past behavior, emotions do not convey the whole complex interactions of different factors, or allow us to notice the changes that have taken place** - _Moreover, the emphasis on global assessments can keep us from seeing and studying dynamic changes in behavior over time and across situations, from appreciating how behavior varies, and is governed, by context, and from understand- ing cascades of behavior, or interactions with others or with our environments that play out as a sequence of events over time._ ^f47f75 **EMA are quick assessment methods to provide us with snap shots of the changes in patient's mood, behavior, experience in the real world across time.** - _Our example is a study of cigarette smoking cessation and relapse (see Shiffman 2005). Smoking is a good target for EMA, as it involves a behav- ior with clearly discernible small-scale events. Tracking experience over time allows the re- search to track the process of quitting and re- lapsing over time. In this study, smokers who had recently quit were asked to monitor their cigarette craving, nicotine withdrawal symp- toms, mood, and activities over several weeks, using palm-top computers as electronic di- aries. Since episodes of smoking (“lapses”) were of key interest, subjects were asked to record any episodes of smoking as they hap- pened, and were then prompted to complete brief assessments of their craving, mood, and activities during the episode. On top of this, about five times each day, at random times, the electronic diaries also prompted, or “beeped,” subjects and administered a similar assess- ment.  These assessments captured not only the events associated with lapses, but the flow of mood, behavior, and events in the hours and days before and after lapses. These assessments captured not only the events associated with lapses, but the flow of mood, behavior, and events in the hours and days before and after lapses._ ^fd7ce5 **Some of the features of EMA.** ^531865 - **Data collected are from real world environment, thus "ecological"** - **Assessments focus on subject moment to moment state of mind (no recollection bias)** - **EMA can be placed on strategic time based on study interests (whether to track craving for smoking, or mood state throughout the day)** - **When subject complete the multiple assessments, it provide a picture of how experiences, and behavior varied across time/situations.** _"This study illustrates several key features common to EMA approaches (Stone & Shiffman 1994, Stone et al. 2007a):_ - _Data are collected in real-world environments, as subjects go about their_ **_Ecological Momentary Assessment (EMA):_** _methods using repeated collection of real-time data on subjects’ behavior and experience in their natural environments lives. This is the “ecological” aspect of EMA and allows generalization to the subjects’ real lives, i.e., ecological validity._ - _Assessments focus on subjects’ current state; for example, self-reports ask about current feelings (or very recent ones), rather than asking for recall or summary over long periods. This is the “momentary” aspect of EMA and aims to avoid the error and bias associated with retrospection._ - _Moments are strategically selected for assessment, whether based on particular features of interest (e.g., occasions when subjects smoked), by random sampling (to characterize subjects’ experiences through representative sampling), or by other sampling schemes._ - _Subjects complete multiple assessments over time, providing a picture of how their experiences and behavior varies over time and across situations. "_ **EMA is not a particular method, or technology, but a collections of methods.** _- i think when case managers check in with the patient's also a form of EMA._ - EMA includes traditional diaries, whether they use paper and pencil (Green et al. 2006), palm-top computers (Shiffman et al. 1996b), or telephones (Perrine et al. 1995). It encompasses interpersonal interaction diaries (Reis & Wheeler 1991), ambulatory physiological monitoring (Kop et al. 2001), and collection of medication compliance data by instrumented pill bottles (Byerly et al. 2005). The technologies differ, the targets of assessment differ, the schedules of data collection differ, but all of these methods focus on collecting data repeatedly, in close to real time, and in subjects’ natural environments. ^2d038d - [Ecological Momentary Assessment. Saul Shiffman, Arthur A. Stone, and Michael R. Hufford](evernote:///view/463671/s5/460709fb-fd5c-2166-bc1c-5d3152ab18ce/c24bc1f0-1ab8-482a-b3ed-5d0ab50ef081/) _HISTORICAL ROOTS_ ^1b0b1a EMA is not new, traditionally, it was written diaries for research. Observation of behavior throughout the day in natural environment, beeping people at random time to record activity, mood/thoughts. - The oldest is the use of written diaries for research (Verbrugge 1980), which was systematically deployed in clinical re- search in the 1940s.  - Self-monitoring of particular behaviors or experiences (Korotitsch & Nelson-Gray 1999) - Self-monitoring of particular targets; a prominent example is the Rochester Interaction Record (Reis & Wheeler 1991), which subjects used to record every social interaction.  - Kansas School of Ecological Research (Barker 1978) on continuous observation of behavior through the day in the natural environment. - ethnographic method of describing individuals’ allocation of time, often to describe differences among societies (Szalai 1966). - Czikszentmihalyi and colleagues (DeVries 1992, Hektner et al. 2007) of the Experience Sampling Method,  using pagers to “beep” people at random times to prompt them to complete diary cards reporting their activity, mood, and/or thoughts.  - wearable cardiac monitors, has been used for several decades as a means of understanding the link between experience and cardiovascular health (Turner et al. 1994). - physiological monitoring to other parameters, such as galvanic skin response, temperature, motion, and others (Wilhelm et al. 2003) - EMA assessment of behaviors (e.g., pill taking; Cramer et al. 1989) and even of the physical environment (e.g., air sampling; Saito et al. 2005). ## **AUTOBIOGRAPHICAL MEMORY AND LIMITATIONS OF RECALL** 1. **Recall bias** ^13c86f 1. Recalling is reconstruction 1. Modern cognitive science considers that much of what we “recall” is actually reconstruction, pieced together from fragmentary inputs through the use of various heuristic strategies. Many experiences are not retained in memory, so often the information we are asked to provide simply is not available for direct retrieval. Experiences are particularly  likely to be encoded and retrieved if they are emotionally salient or are unique; routine experience is less likely to be encoded and harder to retrieve. Moreover, the process of retrieval itself is subject to bias because the accessibility of particular content in memory varies with the subject’s mental state at the time of retrieval. 2. **Using Heuristics to estimates answers. “availability heuristic." bias** ^549a0c 1. research inquiries usually ask subjects not to just retrieve but also to aggregate and summarize their experiences (e.g., “How intense was the pain, on average, today?”). When trying to answer such questions, subjects do not recall, enumerate, and then aggregate their experience over time (Bradburn et al. 1987). Rather, they use a variety of heuristics to estimate the answer. The use of cognitive heuristics and the processes of retrieval account for much of the bias in recall data. 3. **Person's current context and mental state affect recollection of memory. If negative mood, will recall more negative information** ^c36c7e 1. Importantly, the process of memory retrieval is itself subject to bias by the person’s context and mental state at the time of recall. It has been shown, for example, that subjects in a negative mood more easily recall negative information than positive (Kihlstrom et al. 2000).  4. **Memory are "reorganized" to fit into coherent script or theory of events.** ^40537b 1. Besides being distorted by the operation of heuristic recall strategies, memory is also influenced by what we know and believe rather than actually recall. People unconsciously reorganize their “memories” to make them fit a coherent script or theory of events or to reconcile events with what transpired subsequently (Ross 1989). These biases are particularly pernicious because they tend to produce recalled patterns that are coherent and that may conform to theoretical predictions, even if they are false. ## **THE USES OF ECOLOGICAL MOMENTARY ASSESSMENT** Four categories of uses of EMA. 1. Individual differences. 1. **Comparing individuals pre and post intervals** ^0d29eb 1. "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. 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. " 2. **Natural history** Following a subject across time, to understand the course of symptoms, illness. 2. For example, McCarthy et al. (2006) documented the trajectories of various withdrawal symptoms that smokers experi- enced after quitting. The EMA data demon- strated that some symptoms peaked immedi- ately when smokers quit and then decreased over time, while others increased and per- sisted, and still others increased only gradually over time. These patterns contradicted widely held notions about the course of the with- drawal syndrome and were associated with differences in treatment outcome.  ^304ff2 5. **Contextual Associations** Examine contextual associations or interaction between two (or more) phenomena that co-occur in time. 1. _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. 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._ 2. _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._ 3. _Although most designs examine associations between different variables within the same person, an interesting variation considers how one person in a relationship affects the other (Bolger & Laurenceau 2005). For example, Larson & Richards (1994) asked members of families to track their experience in parallel and examined how the mood of each affected the other. They found, for example, that a hus- band’s mood when he comes home from work significantly influences his wife’s mood, but not vice versa._ ^e0dfd1 This is particularly interesting for me, from a systemic perspective, illness are symptoms of relational issues. Often it got something to do with familial/relational dynamics. If we can have this kind of contextual associations analyses from different family members. How each EMA interacts with each other. We can make the "invisible visible" and perhaps even intervene. #Systemic #ideas 4. **Temporal Sequences** ^7296d3 1. to explicitly examine temporal sequences of events or experiences, to document antecedents or consequences of events or behaviors, or to study cascades of events 1. 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. 2. By providing temporal resolution, EMA methods allow investigators to examine sequences of events and experiences and enable them to describe and analyze cascades of events and interactions between events that shape behavior over periods of minutes, hours, or days. Insight into microprocesses—the interplay or cascade of cognitive, affective, and behavioral variables over short intervals of time—is par- ticularly important because many theories of psychopathology and treatment focus on how these processes unfold over time.  **When comparing results from Recall-Based data and EMA, recall-based data tend to yield higher results. i.e Subject recall more frequent, more intense, longer lasting symptoms.** ^1ea470 However, in many domains, recall-based assess- ments tend to yield higher estimated levels than diary ratings of the same target events: That is, symptoms tend to be described as more frequent, more intense, and longer last- ing, sometimes dramatically so (Broderick et al. 2006, Houtveen & Oei 2007, Shiffman 2007, Shiffman et al. 2006; see review in Van den Brink et al. 2001). ^79f0df **Behavioral frequency overestimated in recall.** Behavior frequency is also often overestimated in recall (Homma et al. 2002, Shiffman & Paty 2003). ^d8fe20 **EMA allow for a finer resolution to understand the moment to moment changes in cognition and behaviors** - In other words, even when recall appears adequate to characterize aggregate experience, it is not typically adequate to charac- terize day-to-day changes in cognitions and behaviors of interest, which are typically the focus of EMA research. This highlights one of the unique contributions of EMA to the study of processes that unfold over time. **Construct Validity (What does this mean?) I dont really understand this section.** EMA can be predictive? Kamarck and colleagues (2007) directly contrasted the effect of job strain on cardiovascular outcomes when strain was measured by EMA versus global measures. Subjects filled out a standard global job strain questionnaire and used an electronic diary to collect EMA data on experienced strain every 45 minutes for six days (data from the EMA was averaged to create a single EMA summary variable). The study’s outcome measure was a prospectively assessed biological outcome: the progression of blockage in the carotid artery (which correlates with blockage of coronary arteries) over the subsequent three years. EMA-based measures of job strain predicted progression of arterial occlusion; however, traditional global questionnaire measures of job strain did not. Moreover, heart rate assessed by EMA in the natural environment also independently predicted progression of carotid blockage, whereas heart rate measured in the lab did not. ^bb9429 - Smokers who engaged in "negative affect smoking" tend to relapse after they quit smoking. - Shiffman et al. tested the prediction that smokers engaged in negative-affect smoking would be more vulnerable to relapse after they quit smoking. This was found to be true for EMA-assessed negative-affect smoking, but not for assessments based on standard recall-based questionnaires. ## **ECOLOGICAL MOMENTARY ASSESSMENT DESIGNS AND APPROACHES** **How to design EMA, it's frequency? It can be divided into event-based sampling and time-based sampling schemes** - EMA sampling and assessment schemes can be roughly divided into event-based sampling and time-based sampling schemes (Shiffman 2007, Wheeler & Reis 1991). - Event-based schemes do not aim to characterize subjects’ entire experience, but rather to focus on particular discrete events or episodes in subjects’ lives—e.g., headaches (Niere & Jerak 2004) or drinking episodes (Toddetal.2005)—and organize the data collection around these events. Time-based sampling typically aims to characterise experience more broadly and inclusively—e.g., observing how mood varies over time—without a predefined focus on discrete events. **What is event-based monitoring?** **It could be instances of a relapse of drinking, violence, panic attacks.** ^40d433 - For ex- ample, subjects might be asked to complete an assessment when they have a panic at- tack (Taylor et al. 1990), engage in a so- cial interaction lasting more than 10 minutes (Reis & Wheeler 1991), or take a medica- tion ( Jonasson et al. 1999).  - **It is user defined. User determine if that event has occurred.** - the subjects themselves determine when the event has occurred and initiate an assessment (though some events can be automatically detected by devices; see Kop et al. 2001). - **Recording of events can show frequency and time distribution.** - **User can press a button to log to start recording (other data such as duration, intensity, antecedent mood etc)** - **There is no way to verify/assess compliance. Subject to poor compliance of falsification.** **Time-Based Design** ^61b581 - **Are used to monitor clinical phenomena such as pain, mood, which varied continuously.** - **The frequency of time-based assessments is dependent on resolution the study needed.** - **Whether it's at fixed intervals - common for blood pressure monitoring** - **Or Varied intervals  -** - This guarantees that the sample of assessments will evenly sample time across the day and ensures (subject to missed assessments) that each time block includes an assessment, which allows the time block to serve as the unit of analysis - **Will have to consider the subject burdens in responding to EMAs.  Should be during waking day, 10-10pm etc.** - Although assessing subjects 3 to 5 times per day is common, some studies have succeeded with as many as 20 or more assessments per day (Goldstein et al. 1992; Kamarck et al. 1998, 2002, 2005, 2007). - Assessments should ideally be scheduled throughout the waking day. Some stud- ies have limited assessment to a narrow range of hours (e.g., 10am to 10pm in Kimhy et al. 2006), which misses early-morning and late- night hours that may encompass important— and substantially different—experiences and behaviors. **Combination Designs** ^49a069 **Depending on the nature of the study, time and event based design can be combined.** - **Such as panic attacks (Margraf et al. 1987)** - **binge eating episodes Engel et al. 2007 -- does negative affect come before binge eating?** - **Smoking cessation** - Shiffman & Waters (2004) used time-based data to show that ex-smokers were experiencing escalating levels of affective distress in the hours preced- ing a smoking lapse (the event) and to show that self-efficacy decreased following a lapse, but not after occasions when smokers success- fully resisted a temptation to smoke (Shiffman et al. 1997b)  - **Pain relief after taking medicine** - To test how quickly mi- graine medications delivered pain relief and how long the relief lasted, Sheftell and col- leagues (2005) had subjects record the onset of migraines and then scheduled a series of assessments as follow-ups. - **Drinking habits.** - Muraven et al. (2005) assessed social drinking in subjects throughout the day but also scheduled an assessment each morning to ask about hangovers from the previous night’s drinking. This is useful idea, now i know we have put in a time-based design of EMA, but we can also put in a event based EMA for user to log in when they have events that may be due to episodes of symptoms, distress **Some studies also include some degree of retrospection. Thus researcher must consider the biases even for a short interval.** - Although some EMA studies truly focus on the moment, many assessments involve some degree of retrospection Affleck and colleagues (1998) asked fibromyalgia sub- jects to report on their pain and fatigue over the past 30 minutes. - (Reis & Wheeler 1991) ask subjects about social in- teractions they had just concluded. - since the literature shows that recall can be biased over even a short interval, the researcher needs to carefully consider the use of recall meth- ods and the potential for bias even over short intervals. **even though we may have assessed their mood 12 times in a day, and found them happy each time, it is possible that they experienced moments of misery in between the assessments.  Combine objective (passive data) to compliment active EMA to cover the whole day.** ^bf81e9 - investigators sometimes adopt a coverage strategy, which aims to cover every moment of the day. - For some kinds of objective data, continuous measurement (e.g., actigraphy) is possible, enabling true coverage (e.g., Tulen et al. 2001). - Research suggests that people are particularly poor at keeping track of time and identifying when events took place (Sudman & Bradburn 1973), suggesting that this approach needs to be treated with cau- tion.  - Daily Diaries -- although considered EMA because it track changes across times but comes with bias due to interpretation, recalling inaccuracies ## **USE OF ECOLOGICAL MOMENTARY ASSESSMENT IN TREATMENT** **For assessment** “Let’s figure out what led up to your anxiety attack so we can understand it and think about how to prevent it”) EMA could also prove useful in shedding light on processes and mediators of psychotherapy-induced change.  Protocols to make optimal use of EMA in treatment have yet to be developed. Widespread use of EMA in treatment will also have to overcome both real and perceived barriers of the technical and financial bur- den of these methods. We expect that EMA methods will see increasing use in clinical set- tings over the next decade (see Piasecki et al. 2007 for a review of EMA applied to clinical assessment). ^00b4c3 **For interventions** **EMA-based momentary intervention remains a promising, but only partly proven, idea.  EMA-based treatment can provide behavioral guidance or other interventions (e.g., relaxation stimuli) throughout a patient’s day as well as just at the moment they are needed. #ESA (**[20211026 What is Emotional Self-Awareness ESA?](evernote:///view/463671/s5/529ec799-4e98-88eb-bb5c-7285fa47b54a/c24bc1f0-1ab8-482a-b3ed-5d0ab50ef081/) - This reminded me of EMA helping subjects in increase ESA which can be interventive by itself) - _Newman et al. (2003) reviewed a variety of palm-top-assisted treatments for psychological disorders._ - _Newman et al. (1997) brief palm-top-assisted momentary intervention for panic disorder was equivalent in efficacy to a longer therapist- administered treatment._ - _Momentary interventions have also been described for eating disorders (Norton et al. 2003) and addictive disorders (Riley et al. 2002)._ - _Carter et al. (2007) describe a particularly sophisticated and interactive EMA-based treatment program for smoking (still under evaluation) and present a conceptual foundation of EMA-based treatments_. **This is the idea we have for HOPE-s Design.** - _By learning from an individual’s history, algorithms could, for example, tailor coping suggestions based on what has worked before for this patient in this situation. Furthermore, by observing the patient over time, predictive algorithms could anticipate and respond to challenges before they gain strength, for example, noting rising stress levels and intervening (or contacting a counselor) before they result in maladaptive behavior. In-the-moment interventions have only begun to be explored, but they have the potential to revolutionize clinical treatment._ **The measures (or the questions) we want to use may not be design for EMA purposes. Need to consider whether it make sense.** When self-report assessments are used in EMA, some special considerations are needed. Many questionnaires were not designed for assessing momentary states; the instructions may have a longer recall time frame or no time frame at all. Whether adapting an existing instrument for EMA or creating a new one, it is important to consider whether the item makes sense in the new time frame—i.e., momentary, hourly, etc.—both from the investigator’s conceptual perspective and from the subject’s perspective. ^f7ed21 **Seeing the same questions repeatedly a few times a day can be annoying.** An unusual aspect of EMA studies is that subjects will typically encounter each assess- ment many, many times. This requires that assessments be well tuned: Something that is just a small annoyance when seen once can become a real irritant when encountered five times a day for weeks. ^553d23 **There is still the question of validity and reliability. EMA are still self-reporting.** it is important that assessments be reliable and valid; in EMA, reliability can some- times be achieved through aggregation across multiple assessments rather than across multiple items within a single assessment. The meaning of EMA assessments has to be care- fully considered; Schwarz (2007) has spec- ulated that focusing self-report on immediate experience might shift the individual’s focus to very small events at the cost of the “big picture. It is also important to keep in mind that self-report data collected via EMA methods are still self-report data and are subject to many of the limitations inherent to self-report. Like any self-report data, EMA data can be adversely influenced by the effects of subjects’ psychopathology (Kessler et al. 2000) and by deception or self- deception. ^ad3a62 ## **METHODOLOGICAL CONSIDERATIONS IN ECOLOGICAL MOMENTARY ASSESSMENT STUDIES** **Reactivity** **Behavior or experience can potentially be affected by the act of assessing it.  (_Is it like Questions can be interventive by itself?_), Important if we do not want to introduce confounding factors.** - Reactivity is defined as the potential for behavior or experience to be affected by the act of assessing it. Behavioral studies of self- monitoring, in which patients were asked to monitor the behavior they were trying to change, often demonstrated reduction in the problem behavior due to monitoring alone— so much so that self-monitoring came to be considered a part of behavior-change treatment, not just assessment.  **Reactivity is not universal. It may only be present in some kind of phenomenon. But we don't know when it occur.** ^ - When such conditions are not present, several studies of EMA find little or no evidence of reactive effects (Cruise et al. 1996; Hufford & Shields 2002; Hufford et al. 2002a,b; Hufford & Shiffman 2002; Litt et al. 1998; Stone et al. 1998). Stone and colleagues (2003a) assigned subjects with pain syndromes to complete either no EMA monitoring or sampling of their pain using electronic diaries 3, 6, or 12 times daily. No evidence was found that the pain ratings were systematically reactive to the EMA monitoring. - Given the earlier literature suggesting that reactivity can occur, the literature does not completely resolve when reactive effects might or might not be observed. EMA re- searchers should be alert to the potential for reactivity while recognizing that little evi- dence has been found to support the concern that EMA engenders significant reactivity. ^bcdbcc **Compliance** **Another challenge/consideration is how to ensure subjects comply with answering EMA?** - Missing assessments have the potential to bias the obtained sample of behavior and experience, especially if the missing data are nonrandom **For diary base EMA, subjects may backfiling the entries. Falsification. That result in inaccuracies.** ^fc071f **Special population** **Another consideration is whether children, elderly, mental patients suitable for EMA. Concerns also arise about whether some clinical populations might be unable to perform in EMA studies precisely because of their psychopathology. But should be OK.** - it is notable that several studies have been successfully carried out among schizophrenics (Delespaul 1995, Myin-Germeys et al. 2001), and good compliance using cell phones for EMA re- porting has been reported in a sample of homeless crack addicts (Freedman et al. 2006). These examples suggest that, with appropriate sensitivity, EMA methods and related technology may be useful in a wide array of patient populations and that investigators should not make decisions about feasibility without testing their assumptions. ^bac39f **Selection Bias** **Another consideration is, those to sign up for study, and hardworking enough to complete demanding EMA are not representative of the populations.** A subtler concern that is not addressed by the performance of special populations in EMA studies is that subjects who volun- teer for and complete demanding EMA stud- ies may not be representative. There have been no reports of particular recruitment dif- ficulties or notable deviations in EMA study samples, but this has not been systematically evaluated. It seems likely that personal and environmental factors may discourage some subjects’ participation in EMA studies. Oc- cupational demands may preclude availabil- ity for momentary assessment (consider sur- geons and assembly line workers, although see Goldstein et al. 1992). Also, some work en- vironments may be so noisy as to preclude hearing prompts or using a phone. Motor im- pairments, impaired vision or hearing, and il- literacy may preclude participation in EMA (and in many non-EMA) studies. Finally, sub- jects who are unfamiliar with or fearful of technology may be put off by EMA studies using high-tech devices. The limits of EMA and their impact on studies should be contin- ually evaluated. ^6d5f47 **ANALYSIS OF EMA DATA** The bottom line is that EMA researchers can use easily available software to apply the conceptual models they are familiar with from more traditional between-subjects analyses to EMA data. Besides these relatively familiar statisti- cal models, a variety of novel approaches can fruitfully be applied to EMA data (Walls & Schafer 2006). .. ## **PRACTICAL ISSUES IN ECOLOGICAL MOMENTARY ASSESSMENT** - **Hardware, software** - **data management, integrity, collection, and analysis** **Conclusion** ^4a81d8 I like the following passage "_Clinical psychology—and psychology in general—is prone to overestimate the role of stable traits in determining behavior and to underestimate the influence of the local set- ting on behavior (Mischel 2004)._ _Our behavior in daily life is influenced not just by our predispositions, but also by where we are and whom we are with, by how we are feeling and what situation we are in, by what has recently happened and what we have done or felt in the minutes and hours preceding the present moment._ _One context can elicit dysfunctional behavior while another elicits a healthier response; one can fuel psychopathology or set us on a course toward improvement. Under- standing life as it is lived, up close, will help us better understand both health and pathology and help us see where there are opportunities to intervene on the side of health. This requires methods that examine behav- ior at the appropriate level of granularity: “__Research methods that examine this landscape from 10,000 feet cannot shed light on how this landscape is shaped at ground level” (Shiffman 2005, p. 1743)__. EMA methods provide an important tool to help clinical psychology explore the dynamic nature of behav- ior, thought, and feeling as they unfold over time._ "