Review
Ambulatory assessment in psychopathology research: Current achievements and future ambitions

https://doi.org/10.1016/j.copsyc.2021.01.004Get rights and content

Highlights

  • AA extends traditional lab research by producing ecologically valid findings.

  • AA reveals how emotions and symptoms change and interact with each other over time.

  • Despite AA’s person-specific focus, research still targets the average individual.

  • Contextual information is still largely overlooked in contemporary AA research.

  • AA research should pay more attention to measurement and psychometric validation.

Abstract

Ambulatory assessment (AA) – a collection of methods that aim to track individuals in the realm of everyday life via repeated self-reports or passive mobile sensing – is well established in contemporary psychopathology research. Unravelling the dynamic signature of patients' symptoms and emotions over time and in their own personal ecology, AA methodology has improved our understanding of the real-time pathogenic processes that underlie mental ill-being. In this article, we evaluate the current strengths and shortcomings of AA in psychopathology research and spell out important ambitions for next-generation AA studies to consider. Regarding AA's current achievements, a selective review of recent AA studies underscores the ecological qualities of this method, its ability to bypass retrospective biases in self-report and the introduction of a within-person perspective. Regarding AA's future ambitions, we advocate for a stronger idiosyncratic focus, the incorporation of contextual information and more psychometric scrutiny.

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that are either absent or present, and their simple combination reflecting a consistent clinical syndrome, has recently been replaced by a dynamical systems perspective, in which mental health researchers acknowledge the continuous, time-varying and context-embedded nature of emotion and symptom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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