Everyone is familiar with the concept of a diary, whether you saw it in your favorite childhood movie or even had one yourself growing up.
But this way of putting thoughts to paper goes beyond just a personal desire to keep track of your most treasured moments. Its applications have also been proven quite useful in teletherapy or research, where it goes by a slightly different term: the experience sampling method.
This article looks at some of the technological developments that have benefitted the world of experience sampling, and how this leads to more timely and more accurate data capture.
Experience Sampling Method: A Definition
Initially, the Experience Sampling Method began as a research methodology in which participants are asked to make self-reportings on their feelings, thoughts, and behaviors multiple times of day, immediately after they’ve experienced them.
Participants in this kind of research are generally given journals where they can track these feelings or thoughts. However, with the development of new technologies, these trackings can easily be done through the use of an app on a smartphone or connected device.
Benefits of ESM Data
ESM can bring valuable data to researchers and virtual care practitioners because it relies on live reporting of the criteria followed, such as the quality of life of the participants or their reactions to certain stimuli. In clinical trials, these criteria are often assessed retrospectively, when the participant is asked to fill out a questionnaire a few hours or even days after the events that need monitoring took place.
This means the participant’s recollection of, for instance, how they felt can bring less accurate information in certain cases, as participants can simply forget important details or alter them, later on, to fit them into the questionnaire. In any case, the results can be less accurate. In this way, mental health apps that use ESM may help to reduce recall biases.
From a researcher’s perspective, there is a clear added value that ESM could potentially bring to the table:
- Real-time assessment
- Real-world assessment, as opposed to fabricated or clinical ones
- Multiple assessments over time, which can allow the researchers to follow the track of the participant
- Integration of multiple criteria into the study, such as behavioral data and psychological markers
- Identifying particularities in context or settings that may serve as potential triggers, and
- The ability to provide immediate feedback.
But these benefits can also transcend further than in the context of a trial or research study. Therefore, many believe that using ESM especially in mental health research is essential to providing a better understanding of the experiences trial participants go through.
ESM Applications in Individual Therapy
ESM has been a popular methodology in the context of research, but the popularization of digital tools that can facilitate self-monitoring (smartphones with digital journals, or even apps like the Nudge App, specifically designed to monitor feelings or thoughts) have made way for ESM interventions to extend its applications into the field of individual therapy as well.
Even if this method is not as widespread, some evident benefits can appear:
- ESM doesn’t disrupt the natural flow of real life, meaning patients can fully experience their feelings, moments, or thoughts uninterrupted. Reporting will take place after these moments take place;
- It provides more accurate information to therapists, who can both see the real state the patient is in and monitor their progress effectively;
- The methods employed in individual therapy can be more accurate as a result as well. When therapists have a clearer understanding of the experiences of the patients, their methodology can be better individualized to their needs;
- Patients can benefit from acknowledging and understanding their feelings or reactions better, by having a clear link between them and their triggers.
In one of the first randomized controlled studies into the applications of ESM as a psychological tool, Kramer and colleagues looked into how participants diagnosed with depression benefited from this method in combination with standard antidepressant treatment.
The group which received ESM-based therapy showed a linear decrease in depression symptoms over time that lasted even until the last follow-up which is scheduled six months later.
Based on their findings, two key hypotheses emerged:
- ESM methods could potentially increase insight, which in turn could make the change towards positive behavioral patterns easier;
- The act of first writing down, then sharing their feelings was therapeutic in and of itself, potentially leading to positive results in the study.
ESM provides more accurate information to therapists, who can both see the real state the patient is in, and monitor their progress effectively
It’s important to note, however, that ESM methodology seems to work even better when the patient receives feedback on their monitorization. One group was asked to self-monitor their emotions, but without receiving the input of a therapist to help them understand or explain these feelings. The group which had received feedback showed larger decreases in depression markers than the group that only self-monitored their state.
But although this practice shows great promise, its applications in mental health care are still rather limited. However, with more and more apps for self-monitoring becoming available, it seems that ESM practices could potentially be a lot more prevalent in individual therapies in the following years.
What the Process Looks Like
Using experience sampling methods in individual therapy can look rather different depending on the goals you want to achieve, or the criteria your therapist chooses to focus on during your sessions. Often, specially-designed experience sampling method tools are the go-to when mood tracking, symptom severity, and other mental health measures play an important role in treatment planning.
At its basis, ESM requires a specific design that would allow the therapist or the researchers to dive into a topic; the two most common ones are event-based, and interval-based designs.
Event-based designs will focus on singular episodes of a person’s life that are relevant for measurement, such as panic attacks. If the scope of the therapy is to help a patient control their emotions and lower the frequency of panic attacks, for instance, the therapist may suggest the patient should write down either what lead to the attack (the context of it), how they felt during it, what they did to lower its impact, or what they were feeling right after it.
The patient will then discuss their self-monitoring of the panic attacks in a face-to-face session with the therapist.
Interval-based studies, on the other hand, monitor a patient’s experience over certain events. It is commonly used in medical research, such as testing a patient’s response to a medication. A therapist may recommend this design if, for instance, the patient will be taking a new antidepressant, and ESM is regularly used in psychiatric research.
Other designs can either combine the two or even expand them by integrating other factors that are worth monitoring.
Why is ESM used in Research?
There are many advantages to using the experience sampling method.
- Since the experience sampling methodology is done in one’s natural environment, it has a higher ecological validity.
- ESM also reduces strain on the memory since the actual moment is measured repeatedly over time. This also increases accuracy.
- The assessments are typically collected in different situations over time allowing researchers to better understand and separate the various mental states and psychological frameworks.
- ESM reduces the need for multiple questionnaires which provides a rich data state. 
- Thanks to repeated measures that take place over time, assessment error is greatly reduced.
All of these features help to improve the validity, reliability, and transparency of which is helpful in clinical practices.
The experience sampling methodology makes it much easier for clients during feedback sessions as well, because it helps them to acknowledge and translate the findings to their daily lives.
There are a few perceived disadvantages. The experience sampling methodology may be viewed as time-consuming and even demanding, according to researchers.
Another concern involves selection bias, because there may be patients that are unwilling to participate. ESM does have advantages over more traditional methods typically used in clinical trials. It is a complex assessment method and careful consideration should be taken when using this kind of approach.
The experience sampling method provides a comprehensive view since the same instrument can measure multiple constructs of life.
This kind of broad measurement tool has the potential to replace a much larger body of instruments, making it a valuable approach.
Nonetheless, despite its great potential, some professionals believe it has not yet reached the gold standard in terms of clinical trials.
Studies Using The Experience Sampling Method
According to Verhagen and colleagues, the experience sampling method can be useful when assessing issues such as the quality of life, sensitivity to stress or other types of coping mechanisms.
These types of issues are often much more difficult to measure using more common methodologies, for example, cross-sectional questionnaires.
The experience sampling method can be applied in many different areas including:
- As a naturalistic momentary type of intervention, or
- In clinical trials or single case clinical trials.
The use of technology such as smartphones makes the implementation even easier.
The experience sampling method is actually an overall term that refers to a family of momentary assessment techniques that often use triggers or signals to collect data.
The ESM (experience sampling method) is typically comprised of a number of things, such as a questionnaire done in the morning, to an evening questionnaire, alongside a beep questionnaire.
While ESM survey item content is subject to the theme of the assessment, ESM questions, on the whole, are typically short, so that they can be rated quickly.
Available Reporting Methods
The therapist, sometimes together with the patient, can choose the way in which this data is collected. Generally speaking, the tool for collecting and reporting this information should be simple to use, easy to carry, and not induce much difficulty for the patient, to encourage them to write down the necessary information.
There are, therefore, various ways to do it:
- The Classic Pen to Paper
This is how researchers gathered data in the beginning. Participants in Larson and Csikszentmihalyi‘s original study were asked to always carry with them a journal and a pen or pencil, and write down relevant information based on what the researchers wanted to monitor.This method can also be used in a therapy setting, though it may not be as effective as other methods. The risk is for the patient to forget to take these tools everywhere they go, or simply stop collecting their thoughts because they perceive it as a hassle.
- Text Messages
With more and more people having a cellphone and increasingly more therapy apps, another way to collect data is through text messaging or SMS. This can be an effective method for patients to send the data directly to their therapist, right after the trigger took place.However, managing the data may prove problematic in this case, particularly if the patient has frequent episodes, or the therapist has multiple patients following this design.
Moving into the digital world, email can act as electronic diaries. The principle here is rather similar to that of text messaging – patients can email their therapist as needed, and the data can be easily managed because it is digital.However, one notable problem here in some studies was that the immediacy factor was reduced, as people could only write emails when they had access to a personal computer. Today, since most smartphones carry email apps, this is no longer an issue, however.
- Experience Sampling Method Apps
By far, one of the most preferred reporting methods both from a patient’s and therapist’s perspective. Apps specifically designed for self-monitoring and self-reporting can help facilitate both processes, as some of them may even come with pre-set interfaces that are fabricated for a particular purpose.For instance, there are apps designed to help people with anxiety track their moods and emotions. Users then have to log in and choose from an array of possible feelings, and even recommend calming exercises to help users relax. Many standard Experience Sampling Method tools, like SAM below, use existing or amended psychological scales, while others, like Quenza, allow therapists to design bespoke assessments that suit a clients’ individual needs.
Related: How ABA Software Can Improve Your Practice
The Best ESM Apps
It’s not that surprising that smartphone apps are the most popular ways to conduct ESM designs. These days, mobile apps are designed to be user-friendly, meaning they can be easily learned and used by people of all ages, social backgrounds, education, and demographics. As such, ESM is playing a larger and more important role in mobile therapy.
ESM is playing a larger and more important role in mobile therapy.
Though they are most effective when combined with traditional therapy methods (such as face-to-face discussions), many of these apps offer comprehensive services that allow you to track and even change certain types of behavior. You can use them to start your journey towards well-being.
|This is a journaling app that allows you to keep track of every anxious or negative feeling, as well as track the outcomes of each situation – this can sometimes help you realize some of your fears or anxieties did not prevent you from successfully facing a particular situation.|
There are six categories of worries, so to speak: family, money, health, professional life, and others. You can then review all your logged data, either by day or even in a month or year.
|Good For||Anxiety, Negative Thoughts, Journaling|
|Quenza delivers therapist-designed quizzes, measures, and interventions to your Apple or Android devices – then updates the practitioner with your real-time results and progress. Unlike many other ESM apps, therapists or coaches can share personalized mental health material that they design exclusively for a patient, and all answers are securely stored on a HIPAA-compliant platform for privacy and confidentiality.|
Quenza includes a library of science-based scales, so therapists can easily administer validated psychological assessments to measure mental health symptoms and daily moods. Results and progress can then be integrated with a therapist’s notes, to further refine a patient’s treatment.
|Good For||Experience Sampling, Progress Tracking, Treatment Plans, Psychotherapy Notes, Psychological Assessments|
|With this therapy app, you can monitor your behaviors and thoughts to get a better understanding of the self. Additionally, you can find self-help exercises that can be of help when you’re going through a particularly stressful or bad period.|
SAM even has its own community you can benefit from by sharing experiences (anonymously) with other users that have gone through similar things. Peer therapy, which this is called, can sometimes be very helpful.
|Name||Self-help Anxiety Management (SAM) App|
|Good For||Anxiety, Stress|
|With this app, you can monitor your behaviors and thoughts to get a better understanding of the self. Additionally, you can find self-help exercises that can be of help when you’re going through a particularly stressful or bad period.|
With this app, you can track your emotions and anxiety levels daily. It has an integrated journal and a Thought Checker that can help you identify negative thought patterns. Users can also benefit from activities that can engage them and help improve their mood.
|Good For||Anxiety, Stress|
|This app acts like a journaling and mood-tracking service, in a user-friendly interface. It’s designed to be helpful to the more visually-oriented people by providing an array of videos that can allow you to identify your mood, as opposed to writing it down. You are also able to match the mood to a particular activity and add notes, to have a better understanding of your reactions in certain situations.|
|Good For||Anxiety, Stress, General Mood Tracking|
|This app encourages you to track and manage your moods, while also rating them several times throughout the day. It will also display visual graphs of mood patterns you have, to let you know of dangerous or negative tendencies you may show in your behavior.|
|Good For||Anxiety, Stress, General Mood Tracking|
|The open-source Experience Sampler App is a little different from most. It must be built from the source code. Free to use, modify, and distribute, it is specially designed for ESM studies, and both Android- and iPhone-compatible.|
Features and benefits include:
Many essential features are free, and the app also gives plenty of control over data collection – every response is time-stamped. Its wide platform availability can help reduce selection bias, and it is easily customizable with the ability to design research functions and features.
|Name||Experience Sampler App|
|Good For||General Mood Tracking, Surveys, Data Storage|
The notion that we can take care of our mental health with a piece of software on our smartphones is truly incredible. The world of health care has come a long way in recent years, and no small part is thanks to the development of these blended care technologies.
The experience sampling method, though at first a research design, has shown great potential in the real of individual therapy, particularly when combined with traditional models. Still, even used on their own in the form of apps, they can still help users improve their overall wellbeing by making them much more aware of their emotions, reactions, and behaviors.
We hope you found this article helpful. To start using ESM data and improve your client treatments, don’t forget to try our $1 Quenza monthly trial, for full access to all its online experience sampling features. With real-time reports, HIPAA-compliant data storage, and customizable reports, Quenza will help you measure your patients’ progress and design interventions that have an even bigger positive wellbeing impact.
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