Current methods to assess human anxiety often ignore that anxiety is a dynamic process and have limitations such as high recall bias and low generalizability to real life. Smartphone apps using ecological momentary assessment (EMA) may overcome such limitations. We developed a smartphone app for the longitudinal evaluation of anxiety symptoms using EMA. We assessed the feasibility (retention and compliance) and psychometric properties (reliability and validity) of the app over 6 months in a sample of 99 participants with different levels of anxiety. The EMA-based smartphone app was highly feasible. It showed excellent within-person and between-person reliability, high convergent and moderate discriminant validity, and significant incremental validity. Assessing anxiety longitudinally using a smartphone and following EMA principles is feasible and can be reliable and valid. Studies combining EMA-based anxiety longitudinal assessments with other assessment methods deserve further research and may offer novel insights into human anxiety.
CohenA. S.SchwartzE.LeT.CowanT.CoxC.TuckerR.FoltzP.HolmlundT. B.ElvevågB. (2020). Validating digital phenotyping technologies for clinical use: The critical importance of “resolution.”World Psychiatry, 19(1), 114–115. https://doi.org/10.1002/wps.20703
3.
CranfordJ. A.ShroutP. E.IidaM.RafaeliE.YipT.BolgerN. (2006). A procedure for evaluating sensitivity to within-person change: Can mood measures in diary studies detect change reliably?Personality and Social Psychology Bulletin, 32(7), 917–929. https://doi.org/10.1177/0146167206287721
4.
CraskeM. G.RauchS. L.UrsanoR.PrenoveauJ.PineD. S.ZinbargR. E. (2009). What is an anxiety disorder?Depression and Anxiety, 26(12), 1066–1085. https://doi.org/10.1002/da.20633
DubadM.WinsperC.MeyerC.LivanouM.MarwahaS. (2018). A systematic review of the psychometric properties, usability and clinical impacts of mobile mood-monitoring applications in young people. Psychological Medicine, 48(2), 208–228. https://doi.org/10.1017/S0033291717001659
7.
EdmondsonD.ShafferJ. A.ChaplinW. F.BurgM. M.StoneA. A.SchwartzJ. E. (2013). Trait anxiety and trait anger measured by ecological momentary assessment and their correspondence with traditional trait questionnaires. Journal of Research in Personality, 47(6), 843–852. https://doi.org/10.1016/j.jrp.2013.08.005
8.
EiseleG.VachonH.LafitG.KuppensP.HoubenM.Myin-GermeysI.ViechtbauerW. (2020, September10). The effects of sampling frequency and questionnaire length on perceived burden, compliance, and careless responding in experience sampling data in a student population. Assessment. Advance online publication. https://doi.org/10.1177/1073191120957102
GrupeD. W.NitschkeJ. B. (2013). Uncertainty and anticipation in anxiety: An integrated neurobiological and psychological perspective. Nature Reviews Neuroscience, 14(7), 488–501. https://doi.org/10.1038/nrn3524
11.
HalvorsonM. A.PedersenS. L.FeilM. C.LenguaL. J.MolinaB. S. G.KingK. M. (2021). Impulsive states and impulsive traits: A study of the multilevel structure and validity of a multifaceted measure of impulsive states. Assessment, 28(3), 796–812. https://doi.org/10.1177/1073191120939161
12.
HaynesS. N.LenchH. C. (2003). Incremental validity of new clinical assessment measures. Psychological Assessment, 15(4), 456–466. https://doi.org/10.1037/1040-3590.15.4.456
13.
KesslerR. C.RuscioA. M.ShearK.WittchenH.-U. (2010). Epidemiology of anxiety disorders. Current Topics in Behavioral Neurosciences, 2(2), 21–35. http://www.ncbi.nlm.nih.gov/pubmed/21309104
14.
LangP. J. (1968). Fear reduction and fear behavior: Problems in treating a construct. In ShilenJ. U. H. (Ed.), Research in psychotherapy (Vol. 3, pp. 90–102). American Psychological Association. https://doi.org/10.1037/10546-004
15.
LovibondP. F.LovibondS. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-U
16.
MarwahaS.HeZ.BroomeM.SinghS. P.ScottJ.EydenJ.WolkeD. (2014). How is affective instability defined and measured? A systematic review. Psychological Medicine, 44(9), 1793–1808. https://doi.org/10.1017/S0033291713002407
17.
MerzE. L.RoeschS. C. (2011). Modeling trait and state variation using multilevel factor analysis with PANAS daily diary data. Journal of Research in Personality, 45(1), 2–9. https://doi.org/10.1016/j.jrp.2010.11.003
18.
MeyerT. J.MillerM. L.MetzgerR. L.BorkovecT. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495. https://doi.org/10.1016/0005-7967(90)90135-6
MischelW.ShodaY. (1995). A cognitive-affective system theory of personality: Reconceptualizing situations, dispositions, dynamics, and invariance in personality structure. Psychological Review, 102(2), 246–268. https://doi.org/10.1037/0033-295x.102.2.246
21.
MoranE. K.CulbrethA. J.KandalaS.BarchD. M. (2019). From neuroimaging to daily functioning: A multimethod analysis of reward anticipation in people with schizophrenia. Journal of Abnormal Psychology, 128(7), 723–734. https://doi.org/10.1037/abn0000461
22.
MorrenM.DulmenS.OuwerkerkJ.BensingJ. (2009). Compliance with momentary pain measurement using electronic diaries: A systematic review. European Journal of Pain, 13(4), 354–365. https://doi.org/10.1016/j.ejpain.2008.05.010
23.
R Core Team. (2020). R: A language and environment for statistical computing [Computer software] (4.0.1). R Foundation for Statistical Computing. https://www.r-project.org/
24.
RosenkranzT.TakanoK.WatkinsE. R.EhringT. (2020). Assessing repetitive negative thinking in daily life: Development of an ecological momentary assessment paradigm. PLOS ONE, 15(4), Article e0231783. https://doi.org/10.1371/journal.pone.0231783
25.
SchererK. R. (2009). The dynamic architecture of emotion: Evidence for the component process model. Cognition & Emotion, 23(7), 1307–1351. https://doi.org/10.1080/02699930902928969
26.
SheehanD. V.LecrubierY.SheehanK. H.AmorimP.JanavsJ.WeillerE.HerguetaT.BakerR.DunbarG. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl. 20), 22–33. https://doi.org/10.1016/S0924-9338(99)80239-9
SucalaM.CuijpersP.MuenchF.CardoșR.SoflauR.DobreanA.Achimas-CadariuP.DavidD. (2017). Anxiety: There is an app for that. A systematic review of anxiety apps. Depression and Anxiety, 34(6), 518–525. https://doi.org/10.1002/da.22654
TrullT. J.Ebner-PriemerU. W. (2020). Ambulatory assessment in psychopathology research: A review of recommended reporting guidelines and current practices. Journal of Abnormal Psychology, 129(1), 56–63. https://doi.org/10.1037/abn0000473
34.
TrullT. J.LaneS. P.KovalP.Ebner-PriemerU. W. (2015). Affective dynamics in psychopathology. Emotion Review, 7(4), 355–361. https://doi.org/10.1177/1754073915590617
35.
VachonH.ViechtbauerW.RintalaA.Myin-GermeysI. (2019). Compliance and retention with the experience sampling method over the continuum of severe mental disorders: Meta-analysis and recommendations. Journal of Medical Internet Research, 21(12), Article e14475. https://doi.org/10.2196/14475
36.
Van Den HoutM. A.EngelhardI. M.McNallyR. J. (2017). Thoughts on experimental psychopathology. Psychopathology Review, a4(2), 141–154. https://doi.org/10.5127/pr.045115
37.
VersluisA.VerkuilB.LaneR. D.HagemannD.ThayerJ. F.BrosschotJ. F. (2021). Ecological momentary assessment of emotional awareness: Preliminary evaluation of psychometric properties. Current Psychology, 40(3), 1402–1410. https://doi.org/10.1007/s12144-018-0074-6
38.
WalzL. C.NautaM. H.aan het RotM. (2014). Experience sampling and ecological momentary assessment for studying the daily lives of patients with anxiety disorders: A systematic review. Journal of Anxiety Disorders, 28(8), 925–937. https://doi.org/10.1016/j.janxdis.2014.09.022
39.
WebbC. A.IsraelE. S.BelleauE.ApplemanL.ForbesE. E.PizzagalliD. A. (2021). Mind-wandering in adolescents predicts worse affect and is linked to aberrant default mode network–salience network connectivity. Journal of the American Academy of Child and Adolescent Psychiatry, 60(3), 377–387. https://doi.org/10.1016/j.jaac.2020.03.010
40.
WenC. K. F.SchneiderS.StoneA. A.Spruijt-MetzD. (2017). Compliance with mobile ecological momentary assessment protocols in children and adolescents: A systematic review and meta-analysis. Journal of Medical Internet Research, 19(4), Article e132. https://doi.org/10.2196/jmi
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