Life tracking for clinical psychopharmacology

Life tracking techniques can provide a reliable means by which patients symptoms, thoughts, feelings and behaviors can be recorded in vivo, as they go about their daily lives.

Moskowitz and Young (2006) examined clinical psychopharmacological studies to see what methods were being used to measure affect and social behavior.

They found that the primary method reported was clinician judgment based on first-hand observation or information provided by the patient to the clinician. The second most commonly used method was patient-completed questionnaires.

Twice as many studies examined affect as measured social behavior. Measurements of affect were typically quite detailed with the use of multiple instruments assessing different aspects, whereas measurement of social behavior, was far more coarse-grained, and did not assess a wide range of important factors such as the quality of the social interactions in which patients were involved, characteristic behaviors in social situations, characteristics of others or the context that might have an impact on the individual's symptoms. As the authors put it, "Despite the centrality of social behavior to descriptions of psychopathology, social behavior is examined less frequently and in less detail in psychopharmacological studies than mood and affect." (p. 14).

Clinician reports

Clinician reports are the most common used method in clinical psychopharmacology to investigate social behavior and affect.

The problems with clinician reports:

1. The accuracy of clinician assessments can be affected by familiarity with the individual yet in most studies, clinicians have little contact with participants and so are not at all familiar with the individuals they're assessing. As a result, clinicians rely heavily on info provided by the participant.
• Moskowitz and Young (2006) point to a classic study by Rosenhan (1973) to demonstrate the questionable validity of clinician assessments. In that study, it was found that although clinicians couldn't detect pseudo patients admitted to psychiatric wards, other patients (who spent more time with them) were able to detect who was who.
2. Reliability between multiple clinicians is typically not assessed. When there is an attempt to establish inter-rater reliability, it typically takes the form of different raters coding the same taped clinical interview. Unfortunately, this practice does not establish the the consistency with information is elicited from participants across clinicians.
3. Clinicians have pre-existing assumptions of how various measures co-vary.
• Schachar et al (1986) found that in teachers, defiant behavior in a student influences teachers' evaluations of hyperactivity and inattentiveness (which are believed to be correlated with defiance) such that defiance toward a teacher increases the likelihood that a child will be rated as hyperactive and inattentive, even in the absence of actual observations of hyperactivity and inattentiveness.

Self-report questionnaires

The problems with questionnaires:

1. It is difficult to control for all types of response biases. For example, people who are highly neurotic may be prone to respond more negatively. and to recall symptoms.
2. Responses are affected by one's mood at the time of assessment. Thus assessments made at particular days or times may heavily reflect the timing of the assessment.
3. Recalled information is subject to reconstructive processes.

A method of tracking change that does not rely on clinical assessments or memory would thus prove very useful.

Ecological Momentary Assessment

1. Collect info at pre-specified time intervals. Can be once or several times a day.
2. Signal-contingent recording
1. Reports triggered by a signal that occurs randomly for some fixed number of times per day.
2. All participants given the same number of signals and so report on the same number of events.
3. Events important to the research may be missed.
3. Event-contingent recording
1. Reports triggered by the occurrence of some event.

One of the great advantages of EMA is its ability to investigate changes over time.

• Can look at consistency of affect and behavior over time.
• Can look at the lability of affect and behavior in response to particular events.
• Given enough data, can look at the sequence of things -- whether change in affect might precede or come after changes in behavior.
• The relationship between variables within subjects and the way by which pharmacological agents might impact this relationship can be examined.
• e.g., in depressed patients, the sequence of improvement in mood and improvements in social interactions (duration, agreeableness) can be examined.