Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis
Open accessAbstract
BACKGROUND: Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices. OBJECTIVES: The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance). METHODS: PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool. RESULTS: Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low. CONCLUSIONS: Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being.
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EMIs can help people learn new responses to old triggers by training in the same context in which the maladaptive behavior occurs.
“EMIs can help solve this issue as they allow people to learn new responses to old triggers by training in the same context in which the maladaptive behavior occurs [10].”
The InsightApp's effects are noticeably larger than the average effects reported in previous studies evaluating the effectiveness of EMIs in improving mental health, mental health apps, and mindfulness interventions.
“These effects are noticeably larger than the average effects reported in previous studies evaluating the effectiveness of EMIs in improving mental health [10], mental health apps [35], and mindfulness interventions [7].”
The Versluis et al. meta-analysis found a medium effect size for EMIs on global mental health.
“For the results as a whole, the effect size was medium, the sample size was significant (above 1000), and the publication bias verified, but the other elements did not support quality evidence, with a rating of poor to moderate.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
The Versluis et al. anxiety analysis was rated as poor-quality evidence.
“In a study by Versluis et al [45], a medium effect size was found for EMI on self-management of anxiety symptoms, with poor-quality evidence (because of sample size, heterogeneity of samples, imprecise effect, and no follow-up).”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
The Versluis et al. meta-analysis was rated as poor to moderate quality evidence.
“For the results as a whole, the effect size was medium, the sample size was significant (above 1000), and the publication bias verified, but the other elements did not support quality evidence, with a rating of poor to moderate.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
In Versluis et al., a medium effect size was found for EMI on self-management of anxiety symptoms.
“In a study by Versluis et al [45], a medium effect size was found for EMI on self-management of anxiety symptoms, with poor-quality evidence (because of sample size, heterogeneity of samples, imprecise effect, and no follow-up).”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
In Versluis et al, the effect on depressive symptoms was direct.
“The effect was direct, and publication biases were considered.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
Versluis et al's meta-analysis of ecological momentary interventions for self-management of depressive symptoms found a small to medium effect size.
“Versluis et al [45], looking at EMI for self-management of depressive symptoms, found a small to medium effect size”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
In Versluis et al, the quality of evidence for depressive symptoms was poor because of heterogeneity of samples, imprecise effect, non-RCT design, sample size, and absence of follow-up.
“but the quality of the evidence was judged as poor, given the heterogeneity of the samples, the imprecise effect, the study design (no RCTs), the sample size, and the absence of follow-up.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
In Versluis et al, publication biases were considered.
“The effect was direct, and publication biases were considered.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
Linardon et al's meta-analysis is the most recent but does not include all studies reviewed in Versluis et al's or Firth et al's meta-analyses.
“Linardon et al’s [47] meta-analysis is the most recent but does not include all the studies reviewed in either Versluis et al’s [45] or Firth et al’s [40] meta-analyses, justifying the need to keep all 3 in this meta-review.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
Versluis et al also measured the impact of ecological momentary intervention apps on perceived stress, quality of life, acceptance, and relaxation.
“Versluis et al [45] also measured the impact of EMI apps on perceived stress, quality of life, acceptance, and relaxation.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
In Versluis et al, quality of life had a small to medium effect size with poor to moderate-quality evidence.
“and poor to moderate–quality evidence for the quality of life (only precision and sample size offered a point).”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
In Versluis et al, perceived stress had a small to medium effect size with poor quality evidence.
“Both had small to medium effect sizes with poor quality for perceived stress”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
In Versluis, stand-alone apps were supported by poor evidence compared with poor to moderate evidence for guidance.
“with stand-alone apps being supported by poor evidence compared with poor to moderate evidence for guidance.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
Versluis found a medium to large effect size when guidance was offered, compared with a medium effect size for stand-alone apps.
“Versluis [45] found a medium to large effect size when guidance was offered, compared with medium effect size for stand-alone apps”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [45]
Additional support was the one significant moderator of EMI effects on depression.
“Analysis revealed one significant moderator, which was additional support, which is consistent with findings in other areas of BITs in which supported interventions tend to be more efficacious than unsupported interventions.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
A recent meta-analysis identified 33 EMI studies, 17 of which included a measure of depression as an outcome with levels ranging from mild symptoms to those meeting criteria for major depressive disorder.
“This analysis identified 33 studies, 17 of which included a measure of depression as an outcome with levels ranging from mild symptoms to those meeting criteria for major depressive disorder.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
EMIs can be effective at reducing symptoms of depression and anxiety as well as related outcomes of stress and at increasing positive psychological functioning.
“Previous work has demonstrated that EMIs can be effective at reducing symptoms of depression and anxiety as well as related outcomes of stress and at increasing positive psychological functioning.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
The overall quality rating for the studies analyzed was low, with an average of 2.29 on a six-point scale.
“Importantly, the overall quality rating for the studies analyzed was low, with an average of 2.29 on a sixpoint scale.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
Supported EMIs had larger effect sizes (g = .73) than stand-alone EMIs (g = .45) and stand-alone EMIs provided in combination with care as usual (g = .38).
“Supported EMIs had larger effect sizes (g = .73),suggesting that larger or more consistent results can be obtained with some amount of human support compared with stand-alone EMIs (g = .45)and stand-alone EMIs provided in combination with care as usual (g = .38).”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
EMIs had a small-to-medium effect on within-person change in depressive symptoms of Hedge's g = .48 (95% CI 0.34-0.61).
“EMIs had a small-to-medium effect on withinperson change in depressive symptoms of Hedge's g = .48(95% confidence interval [CI] 0.34-0.61).”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
In a previous review, 15 studies examined anxiety symptoms as an outcome and found a within-person pre-post effect size of g = .47 (95% CI 0.32-0.63), nearly identical to that found for depression.
“In the previous review discussed, 15 studies examined anxiety symptoms as an outcome and found a within-person pre-post effect size of g = .47(95% CI 0.32-0.63),which was nearly identical to that found for studies with depression as an outcome (Versluis et al., 2016).”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
Current evidence supports that EMIs can be beneficial to reduce depression and anxiety and associated aspects of mental health such as stress, acceptance, and quality of life.
“Current evidence supports that EMIs can be beneficial to reduce depression and anxiety and associated aspects of mental health such as stress, acceptance, and quality of life (Gee et al., 2016;Versluis et al., 2016).”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
EMIs for anxiety share similar conceptual diversity and similar efficacy to those for depression.
“EMIs for anxiety share a lot of similarity to those for depression.They have similar conceptual diversity and similar efficacy.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
EMIs previously developed and evaluated have shown similar benefits for depression and anxiety to those found in other BITs such as websites and mobile apps.
“In conclusion, EMIs previously developed and evaluated have shown similar benefits for depression and anxiety to those found in other BITs such as websites and mobile apps.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
Levels of anxiety in EMI studies ranged from mild to clinical ranges.
“Levels of anxiety again ranged from mild to clinical ranges of anxiety.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Versluis et al., 2016
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- Authors
- Versluis, A., Verkuil, B., Spinhoven, P., van der Ploeg, M. M., & Brosschot, J. F.
- Affiliations
- Leiden University (NL)
- Corresponding author
- Versluis, Anke
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2016-06-27
- Volume
- 18
- Issue
- 6
- Pages
- e152
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4940607
- OpenAlex
- W2469312677
- Cited by
- 186
- References
- 77
- Citations by year
- 2026: 19 · 2025: 23 · 2024: 16 · 2023: 24 · 2022: 18 · 2021: 16 · 2020: 28 · 2019: 13 · 2018: 16 · 2017: 10 · 2016: 3
- FWCI
- 2.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- other-oa
- Locations
- Journal of Medical Internet Research (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- ZonMw
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- ecological momentary intervention, mobile health, mental health, anxiety, depression, perceived stress, positive psychological well-being, acceptance, relaxation, quality of life, therapist support, self-management, intervention moderators, digital mental health interventions, cognitive-behavioral training, acceptance and commitment training
- MeSH terms
- Ecological Momentary Assessment, Anxiety, Depression, Humans, Mental Health, Quality of Life, Self Care, Stress, Psychological
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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