ReviewAmbulatory assessment in psychopathology research: Current achievements and future ambitions
Introduction
The traditional conceptualisation of emotions and psychopathological symptoms as monotone or stable entities that are either absent or present, and their simple combination reflecting a consistent clinical syndrome, has recently been replaced by a dynamical systems perspective, in which mental health researchers acknowledge the continuous, time-varying and context-embedded nature of emotion and symptom experiences [1,2,3,4∗]. This theoretical shift has partly been enabled by the accrued adoption of ambulatory assessment (AA [5]) methods in psychopathology research – an umbrella term for different data collection techniques that entail methods such as experience sampling (ESM [6]), ecological momentary assessment (EMA [7]), daily diary methods [8] and mobile sensing [9].
While many AA protocols are unique in their design and the research questions they try to answer, their general premise in psychopathology research is to understand how patients' emotions, appraisals or thoughts, behaviour and psychological complaints naturally unfold in the complexity of everyday life [10]. In AA studies, the focal aim is to capture how these phenomena change within an individual, over time and across contexts. To this end, participants are repeatedly prompted in their daily lives to actively reflect on their momentary experiences via structured self-report surveys [11∗∗]. Passively, participants’ subjective evaluations may be complemented by more objective measures of psychophysiology (e.g. wearables that monitor heartrate, sleep cycles, physical activity, etc. [12]), and the detection of other relevant contextual parameters (e.g. smartphone sensors that track location, proximity, online interaction, etc. [9]), often in a continuous and unobtrusive way.
As the use of AA methods is becoming well-established in psychopathology research, this review aims to evaluate to what extent this data collection technique is currently able to live up to its promises. Specifically, we discuss six key features of AA methodology in light of the recent scientific literature and zoom in on both the strengths this method is able to deliver today and the current shortcomings that leave room for future improvement.
Section snippets
Ecological validity
A first principle of AA is to provide researchers with a unique insight into the daily lives of their participants, drawing on the notion that people's behaviour and experiences only have meaning in the context in which they take place [11∗∗]. As such, AA methodology is able to provide a welcome and essential extension to more experimental research approaches.
Indeed, the extent with which clinical findings from standardised lab studies easily replicate into the realm of ordinary life is a
Idiosyncratic approach
Although AA introduces a within-person perspective to psychopathology research, this methodology is still primarily adopted to determine nomothetic patterns or regularities in symptom and emotion fluctuations (although exceptions exist [20,52,53,54∗∗]). This common practice is remarkable, given that AA studies’ in vivo approach is exceptionally well suited to uncover idiosyncratic associations between different symptoms and emotions and the situations in which they occur. While a discerning
Conclusion
Taken together, these outlined strengths and weaknesses describe AA as a field in motion. While AA has opened the door for answering novel and unprecedented research questions in psychopathology research, we believe the potential of this methodology is far from exhausted. As such, we hope that next-generation AA research embraces the outlined ambitions in this article.
Author contributions
MM and ED conceptualised, wrote and revised this article. Both authors approved the final version.
Funding sources
The preparation of this article was supported by the Research Fund of KU Leuven (C14/19/054). Merijn Mestdagh and Egon Dejonckheere are post-doctoral research fellows supported by the Fund for Scientific Research, Flanders (FWO; 1256221N, 1210621N). The funding sources had no involvement in the actual content of this contribution.
Conflict of interest statement
None declared.
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