Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments
Open accessAbstract
PURPOSE: Psychosocial and health behaviour treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These ecological momentary interventions (EMIs) are treatments that are provided to people during their everyday lives (i.e. in real time) and in natural settings (i.e. real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviours and psychological and physical symptoms. METHODS: Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. RESULTS: There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviours and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. CONCLUSIONS: Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviours and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive.
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- Finding
The review reports that EMI can reduce the number of therapy sessions for anxiety treatment by about half while maintaining similar efficacy.
“In other words, incorporating EMI into treatment allowed the number of therapy sessions to be reduced by about half, while maintaining similar treatment efficacy.”
Quote in the paperNot yet classified - Finding
The review reports that adding EMI to CBT for weight loss produced greater weight loss than CBT alone in one trial.
“In one study participants receiving the CBT and EMI lost more weight than those receiving CBT alone immediately post treatment (8 vs. 3 pounds), and at 24 weeks (16 vs. 4 pounds) and 40 weeks (18 vs. 2 pounds) after the intervention (Burnett et al., 1985), suggesting EMI may enhance treatment gains of CBT.”
Quote in the paperNot yet classified0 of 1 sources checked- cites Burnett et al., 1985 source
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- Finding
Most reviewed studies used mobile devices to supplement other treatments rather than as stand-alone interventions.
“The majority of the studies reviewed provided EMI as only one component in a treatment protocol (k=23, 85%; see Table 2, Additional Treatment Components).”
Quote in the paperNot yet classified - Finding
The paper concludes that EMI have been used as a treatment on their own or, more commonly, as a supplement to other psychological or medical treatments.
“As this review demonstrates, EMI can take many forms, and have been used as a treatment in and of itself or (more commonly) as a supplement to other psychological or medical treatments.”
Quote in the paperNot yet classified - Finding
Participants generally reported that EMI treatments were credible and acceptable.
“Overall, these findings provide evidence that EMI delivered via palmtop computers and mobile phones are perceived as credible and generally acceptable to participants.”
Quote in the paperNot yet classified
- Finding
In controlled smoking cessation studies, participants receiving EMI were more likely to report abstinence after the intervention.
“Half of these studies included a control condition and each found that participants in the EMI conditions were more likely to self-report abstinence after the intervention (Brendryen et al., 2008; Brendryen & Kraft, 2008; Rodgers et al., 2005; Vidrine et al., 2006).”
Quote in the paperNot yet classified0 of 3 sources checked- cites Brendryen et al., 2008
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- cites Brendryen & Kraft, 2008
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Rodgers et al., 2005
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Finding
The review reports that about two-thirds of the studies used tailored EMI content.
“About two-thirds of the studies (k=19) used EMI with tailored content, three (11%) include a combination of tailored and generic messages, and five (19%) used only generic messages (Table 2, EMI Content Tailored).”
Quote in the paperNot yet classified - Finding
The empirical evidence summarized in the review suggests EMI can be effective at encouraging smoking cessation.
“Empirical evidence suggests EMI can be effective at encouraging smoking cessation, improving weight loss in overweight women, and reducing anxiety symptoms.”
Quote in the paperNot yet classified - Finding
The paper states that some controlled weight loss studies suggest EMI may enhance the treatment effects of CBT or psychoeducation.
“These studies provide some evidence that EMI, requiring minimal therapist time and effort, can be used either as an alternative to, or to enhance, CBT or psychoeducation.”
Quote in the paperNot yet classified - Finding
The majority of the studies used an algorithm-based automated system to deliver the EMI.
“The majority of studies (k=19, 70%) used an algorithm-based automated system to deliver the EMI, but one quarter (k=7) required a person to review participant data, select and send appropriate messages, or have a conversation with participants, and one study used a system including both automated and manual EMI deliver”
Quote in the paperNot yet classified - Finding
The review says abbreviated CBT supplemented with EMI can produce similar treatment gains to standard CBT for anxiety disorders in fewer sessions.
“In general, they found individuals receiving brief CBT and EMI experienced similar treatment gains in fewer sessions, as compared to people receiving standard CBT.”
Quote in the paperNot yet classified - Finding
The paper says the electronic devices used for EMI were generally well received by participants and were easy to use.
“Overall, the electronic devices were well received by participants, who reported minimal difficulties remembering to carry the palmtop computers or mobile phones (King et al., 2008; Newman et al., 1999), suggested the devices were easy to use (Newman et al., 1999; Obermayer et al., 2004), and were comfortable responding in social situation (King et al., 2008).”
Quote in the paperNot yet classified0 of 3 sources checked- cites King et al., 2008
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Newman et al., 1999
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Obermayer et al., 2004
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Finding
The review says maintenance of treatment gains over time is mixed, with some studies showing declines and others showing maintenance or continued improvement.
“Although many studies showed treatment gains immediately or shortly after the intervention, there is conflicting evidence regarding the maintenance of effects.”
Quote in the paperNot yet classified - Finding
The review found evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for a variety of health behaviors and symptoms.
“There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviors and physical and psychological symptoms.”
Quote in the paperNot yet classified - Finding
The authors argue that EMI could be used as a cost-effective way of delivering booster treatments over extended periods when effects decline.
“In cases where treatment effects are lost over time, EMI may also have the potential to be used as an easy, cost-effective way of delivering “booster” treatments over extended periods of time, although this has yet to be formally examined.”
Quote in the paperNot yet classified - Finding
The review concludes that EMI are feasible to implement using mobile technology.
“It is clearly feasible to implement EMI using mobile technology; participants demonstrated adequate compliance to the treatment protocol and identified EMI as credible and acceptable forms of treatment.”
Quote in the paperNot yet classified - Finding
The authors recommend integrating assessment and intervention capabilities to create dynamically and individually tailored EMI that are ecologically sensitive.
“Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive.”
Quote in the paperNot yet classified - Finding
The paper concludes that mobile technology-based EMI can be effectively implemented for a variety of health behaviors and psychological and physical symptoms.
“Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviors and psychological and physical symptoms.”
Quote in the paperNot yet classified - Method
The review aims to synthesize and critique mobile technology-based ecological momentary interventions intended to improve health behaviors and psychological and physical symptoms.
“The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviors and psychological and physical symptoms.”
Quote in the paperNot yet classified - Method
The review identified 27 interventions using palmtop computers or mobile phones to deliver ambulatory treatment across several behavioral and health domains.
“Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified.”
Quote in the paperNot yet classified - Background
EMI are interventions provided to people during their everyday lives in real time and in natural settings.
“These Ecological Momentary Interventions [EMI] are treatments that are provided to people during their everyday lives (i.e., in real time) and in natural settings (i.e., real world).”
Quote in the paperNot yet classified - Background
The paper argues that mobile phones and palmtop computers are portable devices that make it possible to deliver interventions during daily life and in real-world settings.
“The use of interventions in patients' natural environments is also being adopted in behavioral health and psychosocial treatment domains more generally.”
Quote in the paperNot yet classified - Background
The review states that tailoring the content and timing of EMI can make them more personally relevant and increase the likelihood of behavior change.
“the overarching rationale for using tailored versus generic messages is tailored information is more personally relevant, increasing the likelihood of thoughtful consideration an helping to enact behavior change (Kreuter et al., 2000).”
Quote in the paperNot yet classified0 of 1 sources checked- cites Kreuter et al., 2000
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- Background
The paper states that EMI extend psychosocial and health behavior treatments beyond traditional research or clinical settings by using mobile technology to deliver interventions during daily life.
“Psychosocial and health behavior treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives.”
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Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Sharing recovery experiences has been demonstrated to allow patients to gain some control over their illness and reduce symptoms in depression, substance use disorders and eating disorders.
“Sharing recovery experiences has been demonstrated to allow patients to gain some control over their illness8 and reduce symptoms in depression,9 substance use disorders10 and eating disorders.11”
From Recovery-focused self-help intervention using vodcasts for patients with personality disorder: Feasibility randomised controlled trial (2024) · cites this paper as [8]
The Treatment Efficacy section (page unavailable) reports some improvement in eating-disorder symptoms during text-message aftercare for patients treated for bulimia nervosa. It describes the two uncontrolled pilot studies as having mixed results and does not establish that sharing recovery experiences caused the improvements, so the claim that this has been demonstrated overstates the evidence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMobile-based interventions show advantages such as high accessibility to the internet, independence of time and location regarding treatment delivery, provision of context-sensitive feedback, real-time data collection, and use of sensor technology for data collection.
“Mobile-based interventions show advantages such as a high accessibility to the internet, independence of time and location regarding treatment delivery, provision of context-sensitive feedback, real-time data collection as well as the use of sensor technology for data collection (Heron and Smyth, 2010; Proudfoot, 2013).”
From A mobile application for panic disorder and agoraphobia: Insights from a multi-methods feasibility study (2020) · cites this paper as Heron and Smyth, 2010
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSimilar findings have been identified in EMI studies for depression, smoking, and other additive behaviors.
“Similar findings have been identified in EMI studies for depression, smoking, and other additive behaviors. 8,45”
From Effectiveness of mobile technologies delivering Ecological Momentary Interventions for stress and anxiety: A systematic review (2016) · cites this paper as [8]
The Treatment Efficacy section reports positive findings for smoking-cessation EMIs and fewer drinking days in a study of college students, supporting the smoking and other addictive-behavior portions of the claim. It does not report comparable EMI treatment findings for depression; its mention of depression scores concerns dropout from a weight-loss study. Page numbers are not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredReal-time tailored feedback can reinforce target behaviors.
“Real-time tailored feedback can reinforce target behaviors [22], which, for individuals with a visible difference, could include the practice of social skills training (an evidence-based component to help individuals manage difficult social encounters [23]), tailored mindfulness practices, and valued goals related to appearance concerns.”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [22]
Other broader reviews have previously noted that more trials are needed on the effectiveness of EMI.
“Other broader reviews have previously noted that more trials are needed on the effectiveness of EMI. 8,20”
From Effectiveness of mobile technologies delivering Ecological Momentary Interventions for stress and anxiety: A systematic review (2016) · cites this paper as [8]
Mobile devices allow the content of interventions to be adapted for each individual not only initially but also over time based on prior outcome data, prior responses, current context, and other variables.
“the content of interventions can be adapted for each individual not only initially but also over time based on his/her prior outcome data, prior responses to specific intervention outputs, current environmental and/or social context, and a range of other variables that might influence the optimal intervention based on the current state of the individual (i.e., ecological momentary interventions) [”
From Health behavior models in the age of mobile interventions: are our theories up to the task? (2011) · cites this paper as [90]
Trials of mobile BITs have found some positive short-term benefits for anxiety disorders.
“Trials of mobile BITs have found some positive short-term benefits for anxiety disorders (39), eating disorders (40), bipolar disorder (41), and schizophrenia (42), although others have not been effective at treating depression (43).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [39]
It is premature to make definitive conclusions about the efficacy of mobile BITs because the literature is limited and of variable quality.
“Given that this literature is limited and of variable quality, it is premature to make any definitive conclusions regarding the efficacy of mobile BITs (39).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [39]
Mobile phone-delivered interventions facilitate frequent engagement and allow users to apply promoted skills and behaviors in real time to real-life experiences.
“Interventions delivered via mobile phones facilitate frequent engagement as users go about their daily lives [12,13] and afford users the opportunity to apply the skills and behaviors promoted by the intervention directly in real time to their real life experiences [14].”
From Feasibility of "CopeSmart": A Telemental Health App for Adolescents (2015) · cites this paper as [14]
Mobile phone interventions can provide almost constant support and are a discrete and confidential means of intervention delivery.
“They can provide almost constant support to users, in comparison to interventions that can only be accessed at specific times or in specific locations (eg, during visits to a therapist’s office) [14]. Furthermore, as it is not unusual to see young people interacting with their mobile phones in public, they provide a discrete and confidential means of intervention delivery [11].”
From Feasibility of "CopeSmart": A Telemental Health App for Adolescents (2015) · cites this paper as [14]
Smartphones offer specific benefits in terms of high user engagement, including the opportunity to deliver ecological momentary interventions.
“The use of smartphones offers specific benefits in terms of high user engagement [42], including the opportunity to deliver ecological momentary interventions [43].”
From Theory-Based Design and Development of a Socially Connected, Gamified Mobile App for Men About Breastfeeding (Milk Man) (2016) · cites this paper as [43]
Mobile health promotion interventions using text messaging or portable devices have produced favorable outcomes in weight loss, physical activity, smoking cessation, and anxiety.
“These interventions have produced favorable outcomes in areas such as weight loss, physical activity, smoking cessation, and anxiety [3-7].”
Ecological momentary interventions and mental health applications are innovative approaches to provide psychological support through mobile devices in everyday life without necessarily involving a real therapist or a face-to-face clinical setting.
“Ecological Momentary Interventions (EMIs) (Heron and Smyth, 2010) and mental health (mHealth) applications (Naslund et al., 2015) are innovative approaches to provide psychological support through mobile devices in everyday life, without necessarily involving the presence of a real therapist or a face-to-face clinical setting.”
From New Technologies for the Understanding, Assessment, and Intervention of Emotion Regulation (2019) · cites this paper as Heron and Smyth, 2010
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting counts of interventions delivered without additional support
MinorOne section says only two interventions provided EMI without additional treatment support. A later section names three studies that did so, adding Agras et al. (1990) to the original two.
“only two interventions (7%) provided EMI without any additional treatment support (Weitzel et al., 2007; Whittaker et al., 2008).”
“Three studies in this review demonstrated EMI can be effectively implemented alone without additional treatment support (Agras et al., 1990; Weitzel et al., 2007; Whittaker et al., 2008)”
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- Authors
- Heron, K. E., & Smyth, J. M.
- Affiliations
- Syracuse University (US)
- Corresponding author
- Smyth, Joshua M.
- Venue
- British Journal of Health Psychology
- Publisher
- Wiley
- Published
- 2010-02
- Volume
- 15
- Issue
- 1
- Pages
- 1-39
- ISSN
- 1359-107X (ISSN-L)
- 2044-8287
- PMC
- PMC2800172
- OpenAlex
- W2048799165
- Cited by
- 1,438
- References
- 74
- Citations by year
- 2026: 94 · 2025: 96 · 2024: 96 · 2023: 88 · 2022: 109 · 2021: 126 · 2020: 115 · 2019: 109 · 2018: 98 · 2017: 103 · 2016: 113 · 2015: 88 · 2014: 72 · 2013: 63 · 2012: 38
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- British Journal of Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (F31MH082564)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- ecological momentary intervention, mobile technology, outpatient care, health behavior change, smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol consumption, physical activity, palmtop computers, mobile devices, treatment efficacy
- MeSH terms
- Adolescent, Adult, Alcoholism, Anxiety Disorders, Feeding and Eating Disorders, Mental Disorders, Child, Diabetes Mellitus, Feeding Behavior, Female, Health Promotion, Humans, Male, Middle Aged, Motor Activity, Obesity, Psychotherapy, Self Care, Weight Loss, Health Behavior, Smoking Cessation, Treatment Outcome, Patient Satisfaction, Computers, Handheld, Cell Phone, Young Adult
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